|
XR Abdomen 2 Views
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
8111094
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.32
|
| Rate for Payer: AlohaCare Medicare |
$39.64
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$43.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.35
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Abdomen 2 Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 74019 26
|
| Hospital Charge Code |
8111096
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$24.32
|
| Rate for Payer: AlohaCare Medicare |
$10.96
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$12.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.35
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.96
|
|
|
XR Abdomen 3plus Views
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
8111097
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$28.57
|
| Rate for Payer: AlohaCare Medicare |
$46.29
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$50.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Abdomen 3plus Views
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
8111097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$215.50
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Devoted Health Medicare |
$237.05
|
| 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 |
$215.50
|
| 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 |
$366.35
|
| Rate for Payer: Humana Medicare |
$215.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.50
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.50
|
| Rate for Payer: University Health Alliance Commercial |
$80.29
|
|
|
XR Abdomen 3plus Views
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
8111097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.35 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
|
|
XR Abdomen 3+ Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 74021 26
|
| Hospital Charge Code |
8111099
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$28.57
|
| Rate for Payer: AlohaCare Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.68
|
|
|
XR Abdomen Complete w Decub and/or Erect
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
1169930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
|
|
XR Abdomen Complete w Decub and/or Erect
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
1169930
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.32
|
| Rate for Payer: AlohaCare Medicare |
$39.64
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$43.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.35
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Abdomen Complete w Decub and/or Erect
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
1169930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: AlohaCare Medicaid |
$290.00
|
| Rate for Payer: AlohaCare Medicare |
$290.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Devoted Health Medicare |
$319.00
|
| 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 |
$290.00
|
| 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 |
$493.00
|
| Rate for Payer: Humana Medicare |
$290.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.00
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
XR Abdomen Complete w Decub and/or Erect - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 74019 26
|
| Hospital Charge Code |
625619
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$24.32
|
| Rate for Payer: AlohaCare Medicare |
$10.96
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$12.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.35
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.96
|
|
|
XR Abdomen Series + Chest 1 View
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
1169932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| 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 |
$354.00
|
| 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 |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$95.72
|
|
|
XR Abdomen Series + Chest 1 View
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
1169932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
XR Abdomen Series + Chest 1 View
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
1169932
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$33.12
|
| Rate for Payer: AlohaCare Medicare |
$54.23
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$59.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.96
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Abdomen Series + Chest 1 View - Report
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 74022 26
|
| Hospital Charge Code |
625631
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$33.12
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.96
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
|
|
XR AC Joints Bilateral
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
1169922
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.19
|
| Rate for Payer: AlohaCare Medicare |
$33.36
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Devoted Health Medicare |
$36.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.32
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR AC Joints Bilateral
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
1169922
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: AlohaCare Medicaid |
$261.50
|
| Rate for Payer: AlohaCare Medicare |
$261.50
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Devoted Health Medicare |
$287.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Humana Medicare |
$261.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$470.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$261.50
|
| Rate for Payer: MDX Hawaii PPO |
$507.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$261.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.74
|
|
|
XR AC Joints Bilateral
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
1169922
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.55 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$470.70
|
| Rate for Payer: MDX Hawaii PPO |
$507.31
|
|
|
XR AC Joints Bilateral - Report
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 73050 26
|
| Hospital Charge Code |
625649
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: AlohaCare Medicaid |
$19.19
|
| Rate for Payer: AlohaCare Medicare |
$9.62
|
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Devoted Health Medicare |
$10.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.32
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.62
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 50
|
| Hospital Charge Code |
1169934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$403.52 |
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.40
|
| Rate for Payer: MDX Hawaii PPO |
$403.52
|
|
|
XR Ankle 2 Views Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73600 50
|
| Hospital Charge Code |
1169934
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.55
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 50
|
| Hospital Charge Code |
1169934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$403.52 |
| Rate for Payer: AlohaCare Medicaid |
$208.00
|
| Rate for Payer: AlohaCare Medicare |
$208.00
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Devoted Health Medicare |
$228.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.20
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Humana Medicare |
$208.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.00
|
| Rate for Payer: MDX Hawaii PPO |
$403.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
XR Ankle 2 Views Bilateral - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73600 26,50
|
| Hospital Charge Code |
625717
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.55
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.55
|
|
|
XR Ankle 2 Views Left
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 LT
|
| Hospital Charge Code |
1169936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$403.52 |
| Rate for Payer: AlohaCare Medicaid |
$208.00
|
| Rate for Payer: AlohaCare Medicare |
$208.00
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Devoted Health Medicare |
$228.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.20
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Humana Medicare |
$208.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.00
|
| Rate for Payer: MDX Hawaii PPO |
$403.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
XR Ankle 2 Views Left
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 LT
|
| Hospital Charge Code |
1169936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$403.52 |
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.40
|
| Rate for Payer: MDX Hawaii PPO |
$403.52
|
|
|
XR Ankle 2 Views Left
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 73600 LT
|
| Hospital Charge Code |
1169936
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.55
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
