|
HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
3207205001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
3207205201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
3207205201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$132.40
|
|
|
HC RADEX X-RAY EXAM ENTIRE SPI 2/3 VW - XR ENTIRE SPINE 2 OR 3 VW
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
3207208201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADEX X-RAY EXAM ENTIRE SPI 2/3 VW - XR ENTIRE SPINE 2 OR 3 VW
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
3207208201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$130.35
|
|
|
HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$72.83
|
|
|
HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIATION THERAPY DOSE PLAN - NM THERAPY SIR SPHERES
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77300
|
| Hospital Charge Code |
3337730001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$152.87
|
|
|
HC RADIATION THERAPY DOSE PLAN - NM THERAPY SIR SPHERES
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77300
|
| Hospital Charge Code |
3337730001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HC RADIATION TREATMENT AID(S)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33377332PB
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HC RADIATION TREATMENT AID(S)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33377332PB
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$198.47 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$161.54
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$80.29
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - FL/XR CHEST 2 VIEWS W/ FLUORO
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104606
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - FL/XR CHEST 2 VIEWS W/ FLUORO
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104606
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST INSPIRATION EXPIRATION
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104504
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST INSPIRATION EXPIRATION
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104504
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
