|
XR Bone Length Studies Scanograms
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
1170016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.30 |
| 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 |
$22.30
|
| 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 |
$28.19
|
| 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 |
$22.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$82.49
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
1170016
|
|
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 Bone Length Studies Scanograms - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 77073 26
|
| Hospital Charge Code |
627647
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$30.08
|
| Rate for Payer: AlohaCare Medicare |
$13.29
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$14.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.29
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.29
|
|
|
XR Calcaneus Bilateral
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 50
|
| Hospital Charge Code |
1170030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
XR Calcaneus Bilateral
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 50
|
| Hospital Charge Code |
1170030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$153.50
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Devoted Health Medicare |
$168.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.65
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$153.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.50
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.50
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
XR Calcaneus Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73650 50
|
| Hospital Charge Code |
1170030
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| 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 |
$29.54
|
| 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 |
$19.02
|
| 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 Calcaneus Bilateral - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73650 26,50
|
| Hospital Charge Code |
629617
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.54
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
|
|
XR Calcaneus Left
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 LT
|
| Hospital Charge Code |
1170032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$153.50
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Devoted Health Medicare |
$168.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.65
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$153.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.50
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.50
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
XR Calcaneus Left
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 LT
|
| Hospital Charge Code |
1170032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
XR Calcaneus Left
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 73650 LT
|
| Hospital Charge Code |
1170032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| 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 |
$29.54
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| 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 |
$19.02
|
| 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 Calcaneus Left - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73650 26,LT
|
| Hospital Charge Code |
629619
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.54
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
|
|
XR Calcaneus Right
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 RT
|
| Hospital Charge Code |
1170034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
XR Calcaneus Right
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 73650 RT
|
| Hospital Charge Code |
1170034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$153.50
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Devoted Health Medicare |
$168.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.65
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$153.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.50
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.50
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
XR Calcaneus Right
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 73650 RT
|
| Hospital Charge Code |
1170034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| 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 |
$29.54
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| 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 |
$19.02
|
| 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 Calcaneus Right - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73650 26,RT
|
| Hospital Charge Code |
629621
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.54
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
|
|
XR Chest 1 View
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
8102143
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$16.90
|
| Rate for Payer: AlohaCare Medicare |
$27.67
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$30.44
|
| 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 |
$34.57
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.20
|
| 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 |
$16.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.67
|
| 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 Chest 1 View
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
8102143
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: AlohaCare Medicaid |
$188.00
|
| Rate for Payer: AlohaCare Medicare |
$188.00
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Devoted Health Medicare |
$206.80
|
| 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 |
$188.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Humana Medicare |
$188.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$188.00
|
| Rate for Payer: MDX Hawaii PPO |
$364.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$188.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$188.00
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
XR Chest 1 View
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
8102143
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$319.60 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.40
|
| Rate for Payer: MDX Hawaii PPO |
$364.72
|
|
|
XR Chest 1 View - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 71045 26
|
| Hospital Charge Code |
8102144
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$16.90
|
| Rate for Payer: AlohaCare Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$9.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.57
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
|
|
XR Chest 2 Views
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$376.55 |
| Max. Negotiated Rate |
$429.71 |
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Health Management Network Commercial |
$376.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.70
|
| Rate for Payer: MDX Hawaii PPO |
$429.71
|
|
|
XR Chest 2 Views
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$429.71 |
| Rate for Payer: AlohaCare Medicaid |
$221.50
|
| Rate for Payer: AlohaCare Medicare |
$221.50
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Devoted Health Medicare |
$243.65
|
| 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 |
$221.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$376.55
|
| Rate for Payer: Humana Medicare |
$221.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.50
|
| Rate for Payer: MDX Hawaii PPO |
$429.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
XR Chest 2 Views - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 71046 26
|
| Hospital Charge Code |
629719
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$10.25
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$11.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.25
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.25
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
1170040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: AlohaCare Medicaid |
$282.50
|
| Rate for Payer: AlohaCare Medicare |
$282.50
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Devoted Health Medicare |
$310.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Humana Medicare |
$282.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.50
|
| Rate for Payer: University Health Alliance Commercial |
$80.64
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
1170040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$480.25 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
|
|
XR Chest 2 Views w/ Apical Lordotic - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 71047 26
|
| Hospital Charge Code |
629721
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$28.11
|
| Rate for Payer: AlohaCare Medicare |
$13.06
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$14.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.20
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.06
|
|
