|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| 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 |
$17.04
|
| 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 |
$18.60
|
| 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 |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307002
|
|
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 X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| 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 |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$68.41
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308002
|
|
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 X-RAY EXAM, BREAST SPECIMEN - MAMMO BREAST SPECIMEN
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
3207609801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: AlohaCare Medicaid |
$645.50
|
| Rate for Payer: AlohaCare Medicare |
$645.50
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Devoted Health Medicare |
$710.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$806.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$645.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.50
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: Humana Medicare |
$645.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,718.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,391.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$645.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$645.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$645.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.66
|
|
|
HC X-RAY EXAM, BREAST SPECIMEN - MAMMO BREAST SPECIMEN
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
3207609801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,318.80 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
3247104701
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$24.39 |
| 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 |
$24.39
|
| 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 |
$27.67
|
| 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 |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$80.64
|
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
3247104701
|
|
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 X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
3207352101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.61 |
| 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 |
$19.61
|
| 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 |
$26.81
|
| 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 |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.40
|
|
|
HC X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
3207352101
|
|
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 X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
3207352201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.36 |
| 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 |
$23.36
|
| 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 |
$31.91
|
| 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 |
$36.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$101.31
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
3207352201
|
|
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 X-RAY EXAM HIPS BI 5+ VWS - XR HIPS BILAT 5+ VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
3207352301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.11 |
| 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 |
$28.11
|
| 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 |
$38.40
|
| 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 |
$41.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$118.03
|
|
|
HC X-RAY EXAM HIPS BI 5+ VWS - XR HIPS BILAT 5+ VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
3207352301
|
|
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 X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.12 |
| 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 |
$14.12
|
| 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 |
$19.28
|
| 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 |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$61.27
|
|
|
HC X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350101
|
|
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 X-RAY EXAM HIP UNI 2-3VIEWS BILAT
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.87 |
| 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 |
$20.87
|
| 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 |
$28.52
|
| 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 |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$86.21
|
|
|
HC X-RAY EXAM HIP UNI 2-3VIEWS BILAT
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350203
|
|
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 X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.86 |
| 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 |
$25.86
|
| 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 |
$35.34
|
| 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 |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$123.25
|
|
|
HC X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350301
|
|
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 X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS BILATERAL
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314003
|
|
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 X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS BILATERAL
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| 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 |
$14.98
|
| 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 |
$15.73
|
| 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 |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$54.96
|
|
|
HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
3207425001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$191.35
|
|
|
HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
3207425001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES ENTEROCLYSIS TUBE
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 74251
|
| Hospital Charge Code |
3207425101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$360.36
|
|
