|
XR Ankle 2 Views Left - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73600 26,LT
|
| Hospital Charge Code |
625719
|
|
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 Right
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 RT
|
| Hospital Charge Code |
1169938
|
|
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 Right
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 73600 RT
|
| Hospital Charge Code |
1169938
|
|
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 Right
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 73600 RT
|
| Hospital Charge Code |
1169938
|
|
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
|
|
|
XR Ankle 2 Views Right - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73600 26,RT
|
| Hospital Charge Code |
625721
|
|
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 Complete 3+ Views Bilateral
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 73610 50
|
| Hospital Charge Code |
1169940
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| 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 |
$24.50
|
| 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 Complete 3+ Views Bilateral
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 50
|
| Hospital Charge Code |
1169940
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
|
|
XR Ankle Complete 3+ Views Bilateral
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 50
|
| Hospital Charge Code |
1169940
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: AlohaCare Medicaid |
$240.50
|
| Rate for Payer: AlohaCare Medicare |
$240.50
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Devoted Health Medicare |
$264.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Humana Medicare |
$240.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.50
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
XR Ankle Complete 3+ Views Bilateral - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73610 26,50
|
| Hospital Charge Code |
625723
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
|
|
XR Ankle Complete 3+ Views Left
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 LT
|
| Hospital Charge Code |
1169942
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
|
|
XR Ankle Complete 3+ Views Left
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 LT
|
| Hospital Charge Code |
1169942
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: AlohaCare Medicaid |
$240.50
|
| Rate for Payer: AlohaCare Medicare |
$240.50
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Devoted Health Medicare |
$264.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Humana Medicare |
$240.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.50
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
XR Ankle Complete 3+ Views Left
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 73610 LT
|
| Hospital Charge Code |
1169942
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| 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 |
$24.50
|
| 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 Complete 3+ Views Left - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73610 26,LT
|
| Hospital Charge Code |
625725
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
|
|
XR Ankle Complete 3+ Views Right
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 RT
|
| Hospital Charge Code |
1169944
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
|
|
XR Ankle Complete 3+ Views Right
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 73610 RT
|
| Hospital Charge Code |
1169944
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$466.57 |
| Rate for Payer: AlohaCare Medicaid |
$240.50
|
| Rate for Payer: AlohaCare Medicare |
$240.50
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Devoted Health Medicare |
$264.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Humana Medicare |
$240.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.50
|
| Rate for Payer: MDX Hawaii PPO |
$466.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
XR Ankle Complete 3+ Views Right
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 73610 RT
|
| Hospital Charge Code |
1169944
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| 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 |
$24.50
|
| 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 Complete 3+ Views Right - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73610 26,RT
|
| Hospital Charge Code |
625727
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
|
|
XR Arthrogram Ankle SI Left
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
2425392
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,292.00 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
|
|
XR Arthrogram Ankle SI Left
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
2425392
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: AlohaCare Medicaid |
$760.00
|
| Rate for Payer: AlohaCare Medicare |
$760.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Devoted Health Medicare |
$836.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Humana Medicare |
$760.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$760.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.00
|
| Rate for Payer: University Health Alliance Commercial |
$212.97
|
|
|
XR Arthrogram Ankle SI Right
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
2425395
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: AlohaCare Medicaid |
$760.00
|
| Rate for Payer: AlohaCare Medicare |
$760.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Devoted Health Medicare |
$836.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Humana Medicare |
$760.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$760.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.00
|
| Rate for Payer: University Health Alliance Commercial |
$212.97
|
|
|
XR Arthrogram Ankle SI Right
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
2425395
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,292.00 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
|
|
XR Arthrogram Elbow Left
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
8127585
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,292.00 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
|
|
XR Arthrogram Elbow Left
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
8127585
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: AlohaCare Medicaid |
$760.00
|
| Rate for Payer: AlohaCare Medicare |
$760.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Devoted Health Medicare |
$836.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Humana Medicare |
$760.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$760.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.00
|
| Rate for Payer: University Health Alliance Commercial |
$206.85
|
|
|
XR Arthrogram Elbow Right
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
8127588
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,292.00 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
|
|
XR Arthrogram Elbow Right
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
8127588
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: AlohaCare Medicaid |
$760.00
|
| Rate for Payer: AlohaCare Medicare |
$760.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Devoted Health Medicare |
$836.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Humana Medicare |
$760.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,368.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$775.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,474.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$760.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.00
|
| Rate for Payer: University Health Alliance Commercial |
$206.85
|
|
