|
XR Arthrogram Injection Wrist Left
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
1169996
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$107.00
|
| Rate for Payer: AlohaCare Medicare |
$107.00
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Devoted Health Medicare |
$117.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.00
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Humana Medicare |
$107.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.00
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.00
|
| Rate for Payer: University Health Alliance Commercial |
$119.84
|
|
|
XR Arthrogram Injection Wrist Right
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115 RT
|
| Hospital Charge Code |
1169998
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Injection Wrist Right
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115 RT
|
| Hospital Charge Code |
1169998
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,803.10
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$203.43
|
|
|
XR Arthrogram Knee Left
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
8127597
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$86.14 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$257.26
|
|
|
XR Arthrogram Knee Left
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
8127597
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Knee Right
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
8127600
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Knee Right
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
8127600
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$86.14 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$257.26
|
|
|
XR Arthrogram Shoulder Left
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
8127603
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| 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 |
$949.00
|
| 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 |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$222.87
|
|
|
XR Arthrogram Shoulder Left
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
8127603
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Shoulder Right
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
8127606
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Shoulder Right
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
8127606
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| 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 |
$949.00
|
| 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 |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$222.87
|
|
|
XR Arthrogram Wrist Left
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
8127609
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$203.43
|
|
|
XR Arthrogram Wrist Left
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
8127609
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Arthrogram Wrist Right
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
8127612
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: AlohaCare Medicaid |
$949.00
|
| Rate for Payer: AlohaCare Medicare |
$949.00
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Devoted Health Medicare |
$1,043.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Humana Medicare |
$949.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$949.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.00
|
| Rate for Payer: University Health Alliance Commercial |
$203.43
|
|
|
XR Arthrogram Wrist Right
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
8127612
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$1,613.30 |
| Max. Negotiated Rate |
$1,841.06 |
| Rate for Payer: Cash Price |
$1,233.70
|
| Rate for Payer: Health Management Network Commercial |
$1,613.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,708.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,841.06
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,061.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
1170002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$901.85 |
| Max. Negotiated Rate |
$1,029.17 |
| Rate for Payer: Cash Price |
$689.65
|
| Rate for Payer: Health Management Network Commercial |
$901.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$954.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,029.17
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,061.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
1170002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$1,029.17 |
| Rate for Payer: AlohaCare Medicaid |
$530.50
|
| Rate for Payer: AlohaCare Medicare |
$530.50
|
| Rate for Payer: Cash Price |
$689.65
|
| Rate for Payer: Cash Price |
$689.65
|
| Rate for Payer: Devoted Health Medicare |
$583.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$530.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$901.85
|
| Rate for Payer: Humana Medicare |
$530.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$954.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$541.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$530.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,029.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$530.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$530.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$530.50
|
| Rate for Payer: University Health Alliance Commercial |
$246.75
|
|
|
XR Barium Enema Complete - Report
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74270 26
|
| Hospital Charge Code |
627609
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$101.76
|
| Rate for Payer: AlohaCare Medicare |
$48.57
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$53.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.38
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.57
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
1170006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: AlohaCare Medicaid |
$558.00
|
| Rate for Payer: AlohaCare Medicare |
$558.00
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Devoted Health Medicare |
$613.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$558.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$948.60
|
| Rate for Payer: Humana Medicare |
$558.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,004.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$569.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$558.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,082.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$558.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$558.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$558.00
|
| Rate for Payer: University Health Alliance Commercial |
$370.48
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
1170006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$948.60 |
| Max. Negotiated Rate |
$1,082.52 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Health Management Network Commercial |
$948.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,004.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,082.52
|
|
|
XR Barium Enema w/ Air Complete - Report
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 74280 26
|
| Hospital Charge Code |
627613
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.77 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: AlohaCare Medicaid |
$146.42
|
| Rate for Payer: AlohaCare Medicare |
$58.77
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Devoted Health Medicare |
$64.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$146.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.77
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
1170014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$341.44 |
| Rate for Payer: AlohaCare Medicaid |
$176.00
|
| Rate for Payer: AlohaCare Medicare |
$176.00
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Devoted Health Medicare |
$193.60
|
| 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 |
$176.00
|
| 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 |
$299.20
|
| Rate for Payer: Humana Medicare |
$176.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.00
|
| Rate for Payer: MDX Hawaii PPO |
$341.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.00
|
| Rate for Payer: University Health Alliance Commercial |
$47.17
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
1170014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$341.44 |
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$299.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.80
|
| Rate for Payer: MDX Hawaii PPO |
$341.44
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
1170014
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$17.10
|
| Rate for Payer: AlohaCare Medicare |
$27.62
|
| 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 |
$30.38
|
| 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 |
$246.64
|
| 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 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: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.14
|
| 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 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 |
$246.64
|
| 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: Ohana Health Plan Medicaid |
$17.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Bone Age Studies - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 77072 26
|
| Hospital Charge Code |
627629
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.10
|
| Rate for Payer: AlohaCare Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Devoted Health Medicare |
$10.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.20
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.20
|
|
