|
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 |
$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 |
$55.57
|
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| 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 |
$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 |
$18.84
|
| 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 |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$68.41
|
|
|
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 |
$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 |
$19.61
|
| 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 |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
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 |
$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 |
$20.87
|
| 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 |
$28.52
|
| 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 |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| 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: Kaiser Permanente Commercial |
$394.20
|
| 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 |
$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 |
$14.98
|
| 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 |
$15.73
|
| 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 |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$54.96
|
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
3207015001
|
|
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 FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
3207015001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| 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 |
$25.96
|
| 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 |
$28.19
|
| 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 |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$87.39
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362001
|
|
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 FOOT 2 VW - XR FOOT 1-2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| 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 |
$19.08
|
| 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 |
$20.03
|
| 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 |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363003
|
|
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 FOREARM 2 VW - XR FOREARM 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309001
|
|
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 FOREARM 2 VW - XR FOREARM 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309001
|
|
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 X-RAY HAND 2 VW - XR HAND 1-2 VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312001
|
|
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 HAND 2 VW - XR HAND 1-2 VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| 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 |
$18.43
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| 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 |
$19.08
|
| 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 |
$20.03
|
| 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 |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313003
|
|
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 HEEL - XR CALCANEUS 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| 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 |
$17.03
|
| 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 |
$17.88
|
| 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 |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
HC X-RAY HEEL - XR CALCANEUS 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365001
|
|
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 HUMERUS - XR HUMERUS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| 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 |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$61.20
|
|
|
HC X-RAY HUMERUS - XR HUMERUS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306002
|
|
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
|
|
