|
US OB < 14 weeks w/ TVS if indicated
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
1169848
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US OB < 14 weeks w/ TVS if indicated - Report
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 76801 26
|
| Hospital Charge Code |
630923
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$153.85 |
| 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: Devoted Health Medicare |
$52.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.42
|
| 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 |
$56.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.42
|
|
|
US OB Detailed Complete First Gest
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
8112319
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$1,077.67 |
| Rate for Payer: AlohaCare Medicaid |
$555.50
|
| Rate for Payer: AlohaCare Medicare |
$555.50
|
| Rate for Payer: Cash Price |
$722.15
|
| Rate for Payer: Cash Price |
$722.15
|
| Rate for Payer: Devoted Health Medicare |
$611.05
|
| 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 |
$555.50
|
| 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 |
$944.35
|
| Rate for Payer: Humana Medicare |
$555.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$999.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$566.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$555.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,077.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$555.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$555.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$555.50
|
| Rate for Payer: University Health Alliance Commercial |
$436.01
|
|
|
US OB Detailed Complete First Gest
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
8112319
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$944.35 |
| Max. Negotiated Rate |
$1,077.67 |
| Rate for Payer: Cash Price |
$722.15
|
| Rate for Payer: Health Management Network Commercial |
$944.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$999.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,077.67
|
|
|
US OB Detailed Complete First Gest - Report
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 76811 26
|
| Hospital Charge Code |
8112321
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$115.61
|
| Rate for Payer: AlohaCare Medicare |
$92.96
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$102.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.96
|
| 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 |
$111.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.96
|
|
|
US OB Follow Up
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
1169854
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$286.50
|
| Rate for Payer: AlohaCare Medicare |
$286.50
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Devoted Health Medicare |
$315.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Humana Medicare |
$286.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.50
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.50
|
| Rate for Payer: University Health Alliance Commercial |
$203.81
|
|
|
US OB Follow Up
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
1169854
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.70
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
|
US OB Follow up POC
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
10248135
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$688.70 |
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Health Management Network Commercial |
$603.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$639.00
|
| Rate for Payer: MDX Hawaii PPO |
$688.70
|
|
|
US OB Follow up POC
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
10248135
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$688.70 |
| Rate for Payer: AlohaCare Medicaid |
$355.00
|
| Rate for Payer: AlohaCare Medicare |
$355.00
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Devoted Health Medicare |
$390.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$355.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$603.50
|
| Rate for Payer: Humana Medicare |
$355.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$639.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$362.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.00
|
| Rate for Payer: MDX Hawaii PPO |
$688.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$355.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$355.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$355.00
|
| Rate for Payer: University Health Alliance Commercial |
$203.81
|
|
|
US OB Follow Up - Report
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 76816 26
|
| Hospital Charge Code |
630912
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$131.75 |
| Rate for Payer: AlohaCare Medicaid |
$72.85
|
| Rate for Payer: AlohaCare Medicare |
$41.79
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Devoted Health Medicare |
$45.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.34
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.79
|
|
|
US OB Greater Than 14 Weeks
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
1169850
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$646.85 |
| Max. Negotiated Rate |
$738.17 |
| Rate for Payer: Cash Price |
$494.65
|
| Rate for Payer: Health Management Network Commercial |
$646.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.90
|
| Rate for Payer: MDX Hawaii PPO |
$738.17
|
|
|
US OB Greater Than 14 Weeks
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
1169850
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$738.17 |
| Rate for Payer: AlohaCare Medicaid |
$380.50
|
| Rate for Payer: AlohaCare Medicare |
$380.50
|
| Rate for Payer: Cash Price |
$494.65
|
| Rate for Payer: Cash Price |
$494.65
|
| Rate for Payer: Devoted Health Medicare |
$418.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$380.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$646.85
|
| Rate for Payer: Humana Medicare |
$380.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$388.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.50
|
| Rate for Payer: MDX Hawaii PPO |
$738.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$380.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.50
|
| Rate for Payer: University Health Alliance Commercial |
$287.45
|
|
|
US OB Greater Than 14 Weeks - Report
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 76805 26
|
| Hospital Charge Code |
630920
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.18 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: AlohaCare Medicaid |
$89.75
|
| Rate for Payer: AlohaCare Medicare |
$48.18
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$53.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.63
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.18
|
|
|
US OB Limited
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
1169856
|
|
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 |
$183.63
|
|
|
US OB Limited
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
1169856
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US OB Limited POC
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
10234941
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US OB Limited POC
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
10234941
|
|
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 |
$183.63
|
|
|
US OB Limited - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76815 26
|
| Hospital Charge Code |
630908
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$34.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.31
|
| 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 |
$37.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.31
|
|
|
US OB Transvaginal
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
1169861
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
|
|
US OB Transvaginal
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
1169861
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US OB Transvaginal - Report
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 76817 26
|
| Hospital Charge Code |
630904
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.17 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: AlohaCare Medicaid |
$61.09
|
| Rate for Payer: AlohaCare Medicare |
$36.17
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Devoted Health Medicare |
$39.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.17
|
|
|
US OB Tranvaginal POC
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
10239193
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US OB Tranvaginal POC
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
10239193
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
|
|
US Paracentesis
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
1169838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$890.00
|
| Rate for Payer: AlohaCare Medicare |
$890.00
|
| Rate for Payer: Cash Price |
$1,157.00
|
| Rate for Payer: Cash Price |
$1,157.00
|
| Rate for Payer: Cash Price |
$1,157.00
|
| Rate for Payer: Devoted Health Medicare |
$979.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,158.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$890.00
|
| Rate for Payer: Health Management Network Commercial |
$1,513.00
|
| Rate for Payer: Humana Medicare |
$890.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,602.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$890.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,726.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$890.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$890.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$890.00
|
| Rate for Payer: University Health Alliance Commercial |
$996.80
|
|
|
US Paracentesis
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
1169838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,513.00 |
| Max. Negotiated Rate |
$1,726.60 |
| Rate for Payer: Cash Price |
$1,157.00
|
| Rate for Payer: Health Management Network Commercial |
$1,513.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,602.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,726.60
|
|
