|
74246 RADEX GI UPR C+ +-GLUC/DLYD FLMS W/O KUB ProFee
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74246 26
|
| Hospital Charge Code |
8102804
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$42.51
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$46.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.51
|
|
|
74248 X-Ray Sm Int F-Thru Std Rad ProFee
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 74248 26
|
| Hospital Charge Code |
8881998
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$32.60
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$35.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.60
|
|
|
74450 URETHROCSTOGRAPY RTRGR RS&I ProFee
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 74450 26
|
| Hospital Charge Code |
8102837
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$61.21
|
| Rate for Payer: AlohaCare Medicare |
$15.63
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$17.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.41
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.63
|
|
|
74450 XR URETHROCYSTOGRAPHY RETROGR
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
9929652
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,048.90 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
|
|
74450 XR URETHROCYSTOGRAPHY RETROGR
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
9929652
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: AlohaCare Medicaid |
$617.00
|
| Rate for Payer: AlohaCare Medicare |
$617.00
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Devoted Health Medicare |
$678.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Humana Medicare |
$617.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$629.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$617.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$617.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.00
|
| Rate for Payer: University Health Alliance Commercial |
$691.04
|
|
|
75989 US Perc Drainage Abscess
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8280921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,225.70 |
| Max. Negotiated Rate |
$1,398.74 |
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Health Management Network Commercial |
$1,225.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,297.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,398.74
|
|
|
75989 US Perc Drainage Abscess
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8280921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$1,398.74 |
| Rate for Payer: AlohaCare Medicaid |
$721.00
|
| Rate for Payer: AlohaCare Medicare |
$721.00
|
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Devoted Health Medicare |
$793.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$721.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,369.90
|
| Rate for Payer: Health Management Network Commercial |
$1,225.70
|
| Rate for Payer: Humana Medicare |
$721.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,297.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$735.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$721.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,398.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$721.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$721.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$721.00
|
| Rate for Payer: University Health Alliance Commercial |
$317.64
|
|
|
76000 FLUOR SPX <1 HR PHYS TM OTH/THN 71023/71034 ProFee
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 76000 26
|
| Hospital Charge Code |
8102936
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$28.01
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.25
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
|
|
76380 CT LMTD/LOCLZD F-UP STD ProFee
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 76380 26
|
| Hospital Charge Code |
8102948
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$207.33 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$45.19
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Devoted Health Medicare |
$49.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.19
|
|
|
76512 POCUS OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
12133642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$444.26 |
| Rate for Payer: AlohaCare Medicaid |
$229.00
|
| Rate for Payer: AlohaCare Medicare |
$229.00
|
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Devoted Health Medicare |
$251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$229.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$389.30
|
| Rate for Payer: Humana Medicare |
$229.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$412.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.00
|
| Rate for Payer: MDX Hawaii PPO |
$444.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$229.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$229.00
|
| Rate for Payer: University Health Alliance Commercial |
$200.08
|
|
|
76512 POCUS OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
12133642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$389.30 |
| Max. Negotiated Rate |
$444.26 |
| Rate for Payer: Cash Price |
$297.70
|
| Rate for Payer: Health Management Network Commercial |
$389.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$412.20
|
| Rate for Payer: MDX Hawaii PPO |
$444.26
|
|
|
76512 POCUS OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Profee
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
12133787
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$104.92 |
| Rate for Payer: AlohaCare Medicaid |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$52.56
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Devoted Health Medicare |
$57.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.92
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.56
|
|
|
76536 US SOFT TISS HEAD&NCK R-T IMG ProFee
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 76536 26
|
| Hospital Charge Code |
8102958
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$73.82
|
| Rate for Payer: AlohaCare Medicare |
$26.93
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Devoted Health Medicare |
$29.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.29
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
76536 US Soft Tissues Head / Neck
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
8280920
|
|
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
|
|
|
76536 US Soft Tissues Head / Neck
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
8280920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$46.98
|
| 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 |
$50.90
|
| 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 |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.00
|
| Rate for Payer: University Health Alliance Commercial |
$211.12
|
|
|
76604 US Chest
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
9887459
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: AlohaCare Medicaid |
$416.50
|
| Rate for Payer: AlohaCare Medicare |
$416.50
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Devoted Health Medicare |
$458.15
|
| 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 |
$416.50
|
| 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 |
$708.05
|
| Rate for Payer: Humana Medicare |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$424.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.50
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
76604 US Chest
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
9887459
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Health Management Network Commercial |
$708.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
|
|
76604 US Chest Bedside POC
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
8279085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: AlohaCare Medicaid |
$416.50
|
| Rate for Payer: AlohaCare Medicare |
$416.50
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Devoted Health Medicare |
$458.15
|
| 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 |
$416.50
|
| 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 |
$708.05
|
| Rate for Payer: Humana Medicare |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$424.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.50
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
76604 US Chest Bedside POC
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
8279085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Health Management Network Commercial |
$708.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
|
|
76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
9301825
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$37.02
|
| Rate for Payer: AlohaCare Medicare |
$65.91
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$72.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.91
|
|
|
76700 US ABDOMINAL R-T W/IMAGE DOCUMENTATION ProFee
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 76700 26
|
| Hospital Charge Code |
8102963
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.17 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$76.97
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Devoted Health Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.90
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
76705 US ABD LIMITIED NONOB
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8102964
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$94.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$104.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| 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 |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
76705 US Abdomen/Lower Back Limited
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
1169569
|
|
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
|
|
|
76705 US Abdomen/Lower Back Limited
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8280904
|
|
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
|
|
|
76705 US Abdomen/Lower Back Limited
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8280904
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$46.98
|
| 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 |
$50.90
|
| 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 |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.00
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
