|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| 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 |
$402.04
|
| 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 |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670501
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC US, CHEST,REAL TIME - US CHEST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
HC US, CHEST,REAL TIME - US CHEST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC US COMPL JOINT R-T W/IMG
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC US COMPL JOINT R-T W/IMG
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| 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 |
$402.04
|
| 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 |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$246.33
|
|
|
HC US, EYE A-SCAN - US EYE A SCAN
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76511
|
| Hospital Charge Code |
4027651101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.81 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$215.08
|
|
|
HC US, EYE A-SCAN - US EYE A SCAN
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76511
|
| Hospital Charge Code |
4027651101
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC US LMTD JT/NONVASC XTR STRUX - US KNEE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| 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 |
$402.04
|
| 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 |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$60.62
|
|
|
HC US LMTD JT/NONVASC XTR STRUX - US KNEE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$260.13
|
|
|
HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
Hospital Revenue Code
|
402
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC VIRAL ID TISS CULT ADD SO
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
|
|
HC VIRAL ID TISS CULT ADD SO
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: AlohaCare Medicaid |
$84.50
|
| Rate for Payer: AlohaCare Medicare |
$128.44
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$141.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$128.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.44
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.44
|
| Rate for Payer: University Health Alliance Commercial |
$23.18
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$96.52
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$106.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$96.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.52
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.52
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$95.72
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361001
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC X-RAY CLAVICLE - XR CLAVICLE
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300001
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC X-RAY CLAVICLE - XR CLAVICLE
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$56.28
|
|
|
HC XRAY CONTROL CATHETER CHANGE - IR GJ TUBE CHANGE
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
3237598401
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$624.75 |
| Max. Negotiated Rate |
$712.95 |
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Health Management Network Commercial |
$624.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$661.50
|
| Rate for Payer: MDX Hawaii PPO |
$712.95
|
|
|
HC XRAY CONTROL CATHETER CHANGE - IR GJ TUBE CHANGE
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
3237598401
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$712.95 |
| Rate for Payer: AlohaCare Medicaid |
$367.50
|
| Rate for Payer: AlohaCare Medicare |
$558.60
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Devoted Health Medicare |
$617.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$558.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.25
|
| Rate for Payer: Health Management Network Commercial |
$624.75
|
| Rate for Payer: Humana Medicare |
$558.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$661.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$374.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$558.60
|
| Rate for Payer: MDX Hawaii PPO |
$712.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$558.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$558.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$558.60
|
| Rate for Payer: University Health Alliance Commercial |
$231.05
|
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
