Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

76817 US OB Transvaginal POC

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	8041472
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

76817 US OB Transvaginal POC

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	8041472
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

76817 US PREG UTRUS TRANSVAG

Professional

Both

$343.00

Service Code	HCPCS 76817 26
Hospital Charge Code	8022162
Hospital Revenue Code	972
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$291.55
Rate for Payer: AlohaCare Medicaid	$61.09
Rate for Payer: AlohaCare Medicare	$36.17
Rate for Payer: Cash Price	$222.95
Rate for Payer: Cash Price	$222.95
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	$291.55
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

76830 POCUS Transvaginal Non-OB Limited ProFee

Professional

Both

$65.00

Service Code	HCPCS 76830
Hospital Charge Code	9280041
Hospital Revenue Code	972
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$142.44
Rate for Payer: AlohaCare Medicaid	$79.51
Rate for Payer: AlohaCare Medicare	$129.49
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$142.44
Rate for Payer: Hawaii Medical Service Association Medicare	$129.49
Rate for Payer: Hawaii Western Management Group Commercial	$105.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$142.44
Rate for Payer: Kaiser Permanente Medicaid	$142.44
Rate for Payer: Kaiser Permanente Medicare	$142.44
Rate for Payer: Ohana Health Plan Medicaid	$79.51
Rate for Payer: Ohana Health Plan Medicare	$129.49
Rate for Payer: UnitedHealthcare Medicaid	$79.51
Rate for Payer: UnitedHealthcare Medicare	$129.49

76830 US Pelvic Transvaginal POC

Professional

Both

$145.00

Service Code	HCPCS 76830
Hospital Charge Code	8041476
Hospital Revenue Code	983
Min. Negotiated Rate	$79.51
Max. Negotiated Rate	$142.44
Rate for Payer: AlohaCare Medicaid	$79.51
Rate for Payer: AlohaCare Medicare	$129.49
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$142.44
Rate for Payer: Hawaii Medical Service Association Medicare	$129.49
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	$142.44
Rate for Payer: Kaiser Permanente Medicaid	$142.44
Rate for Payer: Kaiser Permanente Medicare	$142.44
Rate for Payer: Ohana Health Plan Medicaid	$79.51
Rate for Payer: Ohana Health Plan Medicare	$129.49
Rate for Payer: UnitedHealthcare Medicaid	$79.51
Rate for Payer: UnitedHealthcare Medicare	$129.49

76830 US TRANSVAGINAL

Professional

Both

$276.00

Service Code	HCPCS 76830
Hospital Charge Code	9376637
Hospital Revenue Code	972
Min. Negotiated Rate	$79.51
Max. Negotiated Rate	$234.60
Rate for Payer: AlohaCare Medicaid	$79.51
Rate for Payer: AlohaCare Medicare	$129.49
Rate for Payer: Cash Price	$179.40
Rate for Payer: Cash Price	$179.40
Rate for Payer: Devoted Health Medicare	$142.44
Rate for Payer: Hawaii Medical Service Association Medicare	$129.49
Rate for Payer: Hawaii Western Management Group Commercial	$105.25
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$142.44
Rate for Payer: Kaiser Permanente Medicaid	$142.44
Rate for Payer: Kaiser Permanente Medicare	$142.44
Rate for Payer: Ohana Health Plan Medicaid	$79.51
Rate for Payer: Ohana Health Plan Medicare	$129.49
Rate for Payer: UnitedHealthcare Medicaid	$79.51
Rate for Payer: UnitedHealthcare Medicare	$129.49

76830 US TRANSVAGINAL ProFee

Professional

Both

$140.00

Service Code	HCPCS 76830 26
Hospital Charge Code	8022165
Hospital Revenue Code	972
Min. Negotiated Rate	$33.03
Max. Negotiated Rate	$119.00
Rate for Payer: AlohaCare Medicaid	$79.51
Rate for Payer: AlohaCare Medicare	$33.03
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cash Price	$91.00
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	$119.00
Rate for Payer: Kaiser Permanente Commercial	$36.33
Rate for Payer: Kaiser Permanente Medicaid	$36.33
Rate for Payer: Kaiser Permanente Medicare	$36.33
Rate for Payer: Ohana Health Plan Medicaid	$79.51
Rate for Payer: Ohana Health Plan Medicare	$33.03
Rate for Payer: UnitedHealthcare Medicaid	$79.51
Rate for Payer: UnitedHealthcare Medicare	$33.03

76857 US, pelvic (nonobstetric), limited or follow-up

Facility

$415.00

Service Code	HCPCS 76857
Hospital Charge Code	8041477
Hospital Revenue Code	402
Min. Negotiated Rate	$352.75
Max. Negotiated Rate	$402.55
Rate for Payer: Cash Price	$269.75
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: MDX Hawaii PPO	$402.55

76857 US, pelvic (nonobstetric), limited or follow-up

Facility

$415.00

Service Code	HCPCS 76857
Hospital Charge Code	8041477
Hospital Revenue Code	402
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$402.55
Rate for Payer: AlohaCare Medicaid	$207.50
Rate for Payer: AlohaCare Medicare	$207.50
Rate for Payer: Cash Price	$269.75
Rate for Payer: Cash Price	$269.75
Rate for Payer: Devoted Health Medicare	$228.25
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	$207.50
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	$352.75
Rate for Payer: Humana Medicare	$207.50
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: Kaiser Permanente Medicaid	$211.65
Rate for Payer: Kaiser Permanente Medicare	$207.50
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: Ohana Health Plan Medicaid	$207.50
Rate for Payer: Ohana Health Plan Medicare	$207.50
Rate for Payer: UnitedHealthcare Medicaid	$44.29
Rate for Payer: UnitedHealthcare Medicare	$207.50
Rate for Payer: University Health Alliance Commercial	$161.45

76857 US Pelvis Limited

Facility

$808.00

Service Code	HCPCS 76857
Hospital Charge Code	8280907
Hospital Revenue Code	402
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$783.76
Rate for Payer: AlohaCare Medicaid	$404.00
Rate for Payer: AlohaCare Medicare	$404.00
Rate for Payer: Cash Price	$525.20
Rate for Payer: Cash Price	$525.20
Rate for Payer: Devoted Health Medicare	$444.40
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	$404.00
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	$686.80
Rate for Payer: Humana Medicare	$404.00
Rate for Payer: Kaiser Permanente Commercial	$727.20
Rate for Payer: Kaiser Permanente Medicaid	$412.08
Rate for Payer: Kaiser Permanente Medicare	$404.00
Rate for Payer: MDX Hawaii PPO	$783.76
Rate for Payer: Ohana Health Plan Medicaid	$404.00
Rate for Payer: Ohana Health Plan Medicare	$404.00
Rate for Payer: UnitedHealthcare Medicaid	$44.29
Rate for Payer: UnitedHealthcare Medicare	$404.00
Rate for Payer: University Health Alliance Commercial	$161.45

76857 US Pelvis Limited

Facility

$808.00

Service Code	HCPCS 76857
Hospital Charge Code	8280907
Hospital Revenue Code	402
Min. Negotiated Rate	$686.80
Max. Negotiated Rate	$783.76
Rate for Payer: Cash Price	$525.20
Rate for Payer: Health Management Network Commercial	$686.80
Rate for Payer: Kaiser Permanente Commercial	$727.20
Rate for Payer: MDX Hawaii PPO	$783.76

76870 US Scrotum (Contents)

Facility

$858.00

Service Code	HCPCS 76870
Hospital Charge Code	9325765
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
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	$429.00
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	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$228.81

76870 US Scrotum (Contents)

Facility

$858.00

Service Code	HCPCS 76870
Hospital Charge Code	9325765
Hospital Revenue Code	402
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76881 US EXTREMITY NON-VASC: PROF COMP

Professional

Both

$145.00

Service Code	HCPCS 76881 26
Hospital Charge Code	9930280
Hospital Revenue Code	972
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$133.15
Rate for Payer: AlohaCare Medicaid	$33.68
Rate for Payer: AlohaCare Medicare	$43.84
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$48.22
Rate for Payer: Hawaii Medical Service Association Medicare	$43.84
Rate for Payer: Hawaii Western Management Group Commercial	$133.15
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$48.22
Rate for Payer: Kaiser Permanente Medicaid	$48.22
Rate for Payer: Kaiser Permanente Medicare	$48.22
Rate for Payer: Ohana Health Plan Medicaid	$33.68
Rate for Payer: Ohana Health Plan Medicare	$43.84
Rate for Payer: UnitedHealthcare Medicaid	$33.68
Rate for Payer: UnitedHealthcare Medicare	$43.84

76881 US Lwr Extrem Non Vasc Comp LT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280910
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76881 US Lwr Extrem Non Vasc Comp LT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280910
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
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	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$246.33

76881 US Lwr Extrem Non Vasc Comp RT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280911
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76881 US Lwr Extrem Non Vasc Comp RT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280911
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
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	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$246.33

76881 US Up Extrem Non Vasc Comp LT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280913
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76881 US Up Extrem Non Vasc Comp LT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280913
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
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	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$246.33

76881 US UP Extrem Non Vasc Comp RT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280914
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
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	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$246.33

76881 US UP Extrem Non Vasc Comp RT

Facility

$858.00

Service Code	HCPCS 76881
Hospital Charge Code	8280914
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76882 US Lwr Extrem Non Vasc Ltd LT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280916
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76882 US Lwr Extrem Non Vasc Ltd LT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280916
Hospital Revenue Code	320
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$60.62

76882 US Lwr Extrem Non Vasc Ltd RT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280917
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

Know your out-of-pocket cost for care.

All Charges