|
76705 US Abdomen/Lower Back Limited
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
1169569
|
|
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
|
|
|
76770 US Retroperitoneal Complete
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
8280902
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.94 |
| 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 |
$64.94
|
| 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 |
$70.56
|
| 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 |
$64.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.00
|
| Rate for Payer: University Health Alliance Commercial |
$258.91
|
|
|
76770 US Retroperitoneal Complete
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
8280902
|
|
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
|
|
|
76775 US Retroperitoneal Limited
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
8280905
|
|
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
|
|
|
76775 US Retroperitoneal Limited
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
8280905
|
|
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 |
$202.63
|
|
|
76801 US PG UTER IMG F&MAT 14 WK TABDL 1/1ST GESTATION ProFee
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 76801 26
|
| Hospital Charge Code |
8102970
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$434.26 |
| 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: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$52.16
|
| 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 |
$102.63
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.90
|
| 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 |
$77.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.42
|
| 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
|
|
|
76802 US PG UTER F&MAT 14 WK TABDL EA GESTATION ProFee
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 76802 26
|
| Hospital Charge Code |
8102971
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: AlohaCare Medicaid |
$38.48
|
| Rate for Payer: AlohaCare Medicare |
$40.36
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Devoted Health Medicare |
$44.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.92
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.36
|
|
|
76805 US PG UTER F&MAT AFTER 1ST TRI 1/1ST GESTATION ProFee
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 76805 26
|
| Hospital Charge Code |
8102972
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.18 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: AlohaCare Medicaid |
$89.75
|
| Rate for Payer: AlohaCare Medicare |
$48.18
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$53.00
|
| 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 |
$146.63
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.82
|
| 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 |
$89.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| 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
|
|
|
76810 ñ US OB Fetal/Maternal Eval, => 14 Weeks ìEa Addtl Gestationî
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
9551882
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$292.28 |
| Rate for Payer: AlohaCare Medicaid |
$56.86
|
| Rate for Payer: AlohaCare Medicare |
$95.13
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Devoted Health Medicare |
$104.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.28
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.13
|
|
|
76810 US OB >14 WKS,EA ADD GEST:PROF
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 76810 26
|
| Hospital Charge Code |
9930279
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$292.28 |
| Rate for Payer: AlohaCare Medicaid |
$56.86
|
| Rate for Payer: AlohaCare Medicare |
$48.22
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Devoted Health Medicare |
$53.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.28
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.22
|
|
|
76810 US PG UTER F&MAT AFTER 1ST TRI ABDL EA GESTATION ProFee
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 76810 26
|
| Hospital Charge Code |
8102973
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$56.86
|
| Rate for Payer: AlohaCare Medicare |
$48.22
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Devoted Health Medicare |
$53.04
|
| 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 |
$292.28
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.86
|
| 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 |
$56.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.22
|
| 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
|
|
|
76810 US PG UTER F&MAT AFTER 1ST TRI ABDL EA GESTATION ProFee
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 76810 26
|
| Hospital Charge Code |
8102973
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$292.28 |
| Rate for Payer: AlohaCare Medicaid |
$56.86
|
| Rate for Payer: AlohaCare Medicare |
$48.22
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Devoted Health Medicare |
$53.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.28
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.22
|
|
|
76811 ñ US OB Fetal/Maternal Eval w/Detailed Fetal Anatomic Exam
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
9236479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: AlohaCare Medicaid |
$637.50
|
| Rate for Payer: AlohaCare Medicare |
$637.50
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Devoted Health Medicare |
$701.25
|
| 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 |
$637.50
|
| 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 |
$1,083.75
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,147.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$650.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.50
|
| Rate for Payer: University Health Alliance Commercial |
$436.01
|
|
|
76811 ñ US OB Fetal/Maternal Eval w/Detailed Fetal Anatomic Exam
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
9236479
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$115.61
|
| Rate for Payer: AlohaCare Medicare |
$196.46
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$216.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.46
|
| 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 |
$235.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$235.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.46
|
|
|
76811 ñ US OB Fetal/Maternal Eval w/Detailed Fetal Anatomic Exam
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
9236479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,147.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
|
|
76815 US OB Limited
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8280906
|
|
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
|
|
|
76815 US OB Limited
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8280906
|
|
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 |
$183.63
|
|
|
76815 US OB LIMITED CHARGE
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8280915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$706.16 |
| Rate for Payer: AlohaCare Medicaid |
$364.00
|
| Rate for Payer: AlohaCare Medicare |
$364.00
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Devoted Health Medicare |
$400.40
|
| 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 |
$364.00
|
| 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 |
$618.80
|
| Rate for Payer: Humana Medicare |
$364.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$655.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$371.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.00
|
| Rate for Payer: MDX Hawaii PPO |
$706.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$364.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$364.00
|
| Rate for Payer: University Health Alliance Commercial |
$183.63
|
|
|
76815 US OB LIMITED CHARGE
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8280915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$706.16 |
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Health Management Network Commercial |
$618.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$655.20
|
| Rate for Payer: MDX Hawaii PPO |
$706.16
|
|
|
76815 US OB Limited POC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8041470
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| 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 |
$115.00
|
| 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 |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$183.63
|
|
|
76815 US OB Limited POC
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8041470
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$88.85
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$97.73
|
| 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 |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| 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 |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.85
|
| 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
|
|
|
76815 US OB Limited POC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8041470
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
76815 US OB LIMITED ProFee
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8022161
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$88.85
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$97.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.85
|
| 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 |
$106.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.85
|
|
|
76815 US PG UTER R-T IMG LMTD 1+ FETUSES ProFee
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
8102978
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$88.85
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$97.73
|
| 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 |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| 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 |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.85
|
| 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
|
|
|
76815 US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
9245631
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$88.85
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$97.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| 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 |
$339.46
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| 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 |
$246.64
|
|
