|
HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
3207111001
|
|
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 |
$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 |
$25.96
|
| 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 |
$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 |
$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 |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$85.69
|
|
|
HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS W/ CHEST ANTEROPOSTERIOR
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3207110101
|
|
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 RIBS, CHEST 3+ VW - XR RIBS 2 VWS W/ CHEST ANTEROPOSTERIOR
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3207110101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| 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 |
$21.96
|
| 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 |
$24.13
|
| 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 |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$80.36
|
|
|
HC X-RAY RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
3207111101
|
|
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 RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
3207111101
|
|
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 |
$105.84
|
|
|
HC X-RAY SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
3207220201
|
|
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 SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
3207220201
|
|
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 |
$22.35
|
| 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 |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$71.43
|
|
|
HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
3207222001
|
|
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 |
$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 |
$18.84
|
| 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 |
$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 |
$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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$62.01
|
|
|
HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
3207222001
|
|
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 SCAPULA - XR SCAPULA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301001
|
|
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 SCAPULA - XR SCAPULA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| 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 |
$17.04
|
| 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 |
$18.60
|
| 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 |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
HC X-RAYS FOR BONE AGE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
3207707201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.46 |
| 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 |
$10.46
|
| 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 |
$18.60
|
| 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 |
$10.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$47.17
|
|
|
HC X-RAYS FOR BONE AGE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
3207707201
|
|
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 SHOULDER 1 VW - XR SHOULDER 1 VIEW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302002
|
|
Hospital Revenue Code
|
320
|
| 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 |
$16.87
|
| 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 |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$49.15
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302002
|
|
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 SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS BILATERAL
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303001
|
|
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 SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS BILATERAL
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303001
|
|
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 |
$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 |
$18.84
|
| 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 |
$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 |
$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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$61.92
|
|
|
HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
3207021002
|
|
Hospital Revenue Code
|
320
|
| 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 |
$22.35
|
| 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 |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
3207021002
|
|
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 SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
3207022001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| 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 |
$25.96
|
| 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 |
$28.19
|
| 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 |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$82.68
|
|
|
HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
3207022001
|
|
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 SKULL <4 VW - XR SKULL 1-3 VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
3207025001
|
|
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 |
$22.35
|
| 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 |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$72.65
|
|
|
HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
3207025001
|
|
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 SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
3207026001
|
|
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 |
$100.57
|
|
|
HC X-RAY SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
3207026001
|
|
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
|
|
