|
HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: AlohaCare Medicaid |
$169.50
|
| Rate for Payer: AlohaCare Medicare |
$105.09
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Devoted Health Medicare |
$115.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.05
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Humana Medicare |
$105.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.09
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.09
|
| Rate for Payer: University Health Alliance Commercial |
$247.10
|
|
|
HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
|
|
HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4209753001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4209753001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: AlohaCare Medicare |
$56.11
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$61.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Humana Medicare |
$56.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.11
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.11
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
HC PT THERAPEUTIC EXERCISES
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4209711001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$43.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$47.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$43.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.40
|
| Rate for Payer: University Health Alliance Commercial |
$102.05
|
|
|
HC PT THERAPEUTIC EXERCISES
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4209711001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: AlohaCare Medicaid |
$77.00
|
| Rate for Payer: AlohaCare Medicare |
$47.74
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Devoted Health Medicare |
$52.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.30
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Humana Medicare |
$47.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.74
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.74
|
| Rate for Payer: University Health Alliance Commercial |
$112.25
|
|
|
HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
|
|
HC PUNCTURE DRAINAGE OF LESION
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
3611016001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$492.90
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$492.90
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$492.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC PUNCTURE DRAINAGE OF LESION
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
3611016001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
3207204002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
3207204002
|
|
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 RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
3207205001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$105.14
|
|
|
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: Kaiser Permanente Commercial |
$476.10
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| 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 |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$132.40
|
|
|
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: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
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 |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
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 |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| 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: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
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: Kaiser Permanente Commercial |
$476.10
|
| 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 |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$80.29
|
|
|
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 |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| 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: Kaiser Permanente Commercial |
$394.20
|
| 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 |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
