|
US Retroperitoneal Complete
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
1169867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.94 |
| 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 |
$64.94
|
| 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 |
$70.56
|
| 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 |
$64.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$258.91
|
|
|
US Retroperitoneal Complete - Report
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 76770 26
|
| Hospital Charge Code |
630894
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$127.33 |
| Rate for Payer: AlohaCare Medicaid |
$71.79
|
| Rate for Payer: AlohaCare Medicare |
$34.70
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| 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 |
$127.33
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.70
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
1169869
|
|
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 Retroperitoneal Limited
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
1169869
|
|
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 |
$202.63
|
|
|
US Retroperitoneal Limited POC
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
10248583
|
|
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 Retroperitoneal Limited POC
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
10248583
|
|
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 |
$202.63
|
|
|
US Retroperitoneal Limited - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76775 26
|
| Hospital Charge Code |
630856
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$27.59
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$30.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.29
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.59
|
|
|
US Scrotum Contents
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
8100937
|
|
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 |
$133.51
|
| 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 |
$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 |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$228.81
|
|
|
US Scrotum Contents
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
8100937
|
|
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 Scrotum (Contents) POC
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
10239194
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| 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 |
$50.35
|
| 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 |
$54.65
|
| 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 |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.50
|
| Rate for Payer: University Health Alliance Commercial |
$228.81
|
|
|
US Scrotum (Contents) POC
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
10239194
|
|
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 Scrotum (Contents) - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76870 26
|
| Hospital Charge Code |
8100939
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$66.47
|
| Rate for Payer: AlohaCare Medicare |
$30.22
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$33.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.84
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.22
|
|
|
US Segmental Pressures LE 3+ Lvls Bilat
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
1169755
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$102.27 |
| Max. Negotiated Rate |
$677.06 |
| Rate for Payer: AlohaCare Medicaid |
$349.00
|
| Rate for Payer: AlohaCare Medicare |
$349.00
|
| Rate for Payer: Cash Price |
$453.70
|
| Rate for Payer: Cash Price |
$453.70
|
| Rate for Payer: Devoted Health Medicare |
$383.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$663.10
|
| Rate for Payer: Health Management Network Commercial |
$593.30
|
| Rate for Payer: Humana Medicare |
$349.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$628.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$349.00
|
| Rate for Payer: MDX Hawaii PPO |
$677.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.00
|
| Rate for Payer: University Health Alliance Commercial |
$508.77
|
|
|
US Segmental Pressures LE 3+ Lvls Bilat
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
1169755
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$593.30 |
| Max. Negotiated Rate |
$677.06 |
| Rate for Payer: Cash Price |
$453.70
|
| Rate for Payer: Health Management Network Commercial |
$593.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$628.20
|
| Rate for Payer: MDX Hawaii PPO |
$677.06
|
|
|
US SMA with Doppler
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
8127582
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: AlohaCare Medicaid |
$947.50
|
| Rate for Payer: AlohaCare Medicare |
$947.50
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Devoted Health Medicare |
$1,042.25
|
| 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 |
$947.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,800.25
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Humana Medicare |
$947.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$947.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$947.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$947.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$947.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,381.27
|
|
|
US SMA with Doppler
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
8127582
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,610.75 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
|
|
US SMA with Doppler - Report
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 93976 26
|
| Hospital Charge Code |
8127584
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$176.72 |
| Rate for Payer: AlohaCare Medicaid |
$176.72
|
| Rate for Payer: AlohaCare Medicare |
$37.65
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| 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 |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.41
|
| 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
|
|
|
US Soft Tissue Abd/Pel
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8100943
|
|
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 Soft Tissue Abd/Pel
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8100943
|
|
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 Soft Tissue Abd/Pel - Report
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76705 26
|
| Hospital Charge Code |
8100945
|
|
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 |
$30.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.72
|
| 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 Soft Tissue Buttocks or Pelvic Wall
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
8463493
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$1,184.37 |
| Rate for Payer: AlohaCare Medicaid |
$610.50
|
| Rate for Payer: AlohaCare Medicare |
$610.50
|
| Rate for Payer: Cash Price |
$793.65
|
| Rate for Payer: Cash Price |
$793.65
|
| Rate for Payer: Devoted Health Medicare |
$671.55
|
| 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 |
$610.50
|
| 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 |
$1,037.85
|
| Rate for Payer: Humana Medicare |
$610.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$622.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$610.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,184.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$610.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$610.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$610.50
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
US Soft Tissue Buttocks or Pelvic Wall
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
8463493
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,037.85 |
| Max. Negotiated Rate |
$1,184.37 |
| Rate for Payer: Cash Price |
$793.65
|
| Rate for Payer: Health Management Network Commercial |
$1,037.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,184.37
|
|
|
US Soft Tissue Buttocks or Pelvic Wall - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76857 26
|
| Hospital Charge Code |
8463495
|
|
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 |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.58
|
| 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 Soft Tissue Chest or Upper Back
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
8463496
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$1,256.15 |
| Rate for Payer: AlohaCare Medicaid |
$647.50
|
| Rate for Payer: AlohaCare Medicare |
$647.50
|
| Rate for Payer: Cash Price |
$841.75
|
| Rate for Payer: Cash Price |
$841.75
|
| Rate for Payer: Devoted Health Medicare |
$712.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$647.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Humana Medicare |
$647.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,165.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$660.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$647.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,256.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$647.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$647.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$647.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
US Soft Tissue Chest or Upper Back
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
8463496
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,100.75 |
| Max. Negotiated Rate |
$1,256.15 |
| Rate for Payer: Cash Price |
$841.75
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,165.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,256.15
|
|
