|
76857 US, pelvic (nonobstetric), limited or follow-up
|
Facility
|
IP
|
$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
|
OP
|
$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
|
IP
|
$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
|
|
|
76857 US Pelvis Limited
|
Facility
|
OP
|
$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
|
|
|
76870 US SCROTUM&CNTS ProFee
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 76870 26
|
| Hospital Charge Code |
8102993
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$66.47
|
| Rate for Payer: AlohaCare Medicare |
$30.22
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Devoted Health Medicare |
$33.24
|
| 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 |
$101.84
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.26
|
| 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 |
$66.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.22
|
| 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
|
|
|
76870 US Scrotum (Contents)
|
Facility
|
IP
|
$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
|
|
|
76870 US Scrotum (Contents)
|
Facility
|
OP
|
$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
|
|
|
76881 Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-t
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
9697258
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$33.68
|
| Rate for Payer: AlohaCare Medicare |
$56.18
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$61.80
|
| 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 |
$133.15
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.42
|
| 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 |
$33.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.18
|
| 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
|
|
|
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 |
$52.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.61
|
| 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
|
OP
|
$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 LT
|
Facility
|
IP
|
$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 RT
|
Facility
|
OP
|
$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 Lwr Extrem Non Vasc Comp RT
|
Facility
|
IP
|
$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 Up Extrem Non Vasc Comp LT
|
Facility
|
OP
|
$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 LT
|
Facility
|
IP
|
$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 RT
|
Facility
|
IP
|
$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
|
|
|
76881 US UP Extrem Non Vasc Comp RT
|
Facility
|
OP
|
$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
|
|
|
76882 US EXTREMITY NON-VASC REAL-TIME IMG LMTD ProFee
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76882 26
|
| Hospital Charge Code |
8102998
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: AlohaCare Medicare |
$32.65
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$35.91
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.18
|
| 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 |
$40.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.65
|
| 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
|
|
|
76882 US Lwr Extrem Non Vasc Ltd LT
|
Facility
|
IP
|
$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
|
OP
|
$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
|
OP
|
$858.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
8280917
|
|
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
|
IP
|
$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
|
|
|
76882 US Up Extrem Non Vasc Ltd LT
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
8280918
|
|
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 Up Extrem Non Vasc Ltd LT
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
8280918
|
|
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 Up Extrem Non Vasc Ltd RT
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
8280919
|
|
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
|
|
