|
XR Cystogram/Urethrogram Injection
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
9803541
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$708.10 |
| Rate for Payer: AlohaCare Medicaid |
$365.00
|
| Rate for Payer: AlohaCare Medicare |
$365.00
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Devoted Health Medicare |
$401.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$365.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$693.50
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Humana Medicare |
$365.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$365.00
|
| Rate for Payer: MDX Hawaii PPO |
$708.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$365.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$365.00
|
| Rate for Payer: University Health Alliance Commercial |
$408.80
|
|
|
XR Cystogram/Urethrogram Injection - Report
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
9803543
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$58.80
|
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Devoted Health Medicare |
$64.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$100.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$287.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.80
|
| Rate for Payer: University Health Alliance Commercial |
$85.04
|
|
|
XR Drainage Perc Cath Placement
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8207975
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: AlohaCare Medicaid |
$617.00
|
| Rate for Payer: AlohaCare Medicare |
$617.00
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Devoted Health Medicare |
$678.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,172.30
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Humana Medicare |
$617.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$629.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$617.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$617.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.00
|
| Rate for Payer: University Health Alliance Commercial |
$317.64
|
|
|
XR Drainage Perc Cath Placement
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8207975
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,048.90 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
|
|
XR Drainage Perc Cath Placement - Report
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 75989 26
|
| Hospital Charge Code |
8207977
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: AlohaCare Medicaid |
$72.05
|
| Rate for Payer: AlohaCare Medicare |
$55.10
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$60.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.69
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.10
|
|
|
XR Elbow 2 Views Bilateral
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 50
|
| Hospital Charge Code |
1170119
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$277.95 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
|
|
XR Elbow 2 Views Bilateral
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 50
|
| Hospital Charge Code |
1170119
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: AlohaCare Medicaid |
$163.50
|
| Rate for Payer: AlohaCare Medicare |
$163.50
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Devoted Health Medicare |
$179.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.65
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Humana Medicare |
$163.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.50
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
XR Elbow 2 Views Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73070 50
|
| Hospital Charge Code |
1170119
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| 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 |
$31.36
|
| 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 |
$19.48
|
| 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 Elbow 2 Views Bilateral - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73070 26,50
|
| Hospital Charge Code |
630692
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
|
|
XR Elbow 2 Views Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73070 LT
|
| Hospital Charge Code |
1170121
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| 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 |
$31.36
|
| 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 |
$19.48
|
| 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 Elbow 2 Views Left
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 LT
|
| Hospital Charge Code |
1170121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$277.95 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
|
|
XR Elbow 2 Views Left
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 LT
|
| Hospital Charge Code |
1170121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: AlohaCare Medicaid |
$163.50
|
| Rate for Payer: AlohaCare Medicare |
$163.50
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Devoted Health Medicare |
$179.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.65
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Humana Medicare |
$163.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.50
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
XR Elbow 2 Views Left - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73070 26,LT
|
| Hospital Charge Code |
630690
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
|
|
XR Elbow 2 Views Right
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73070 RT
|
| Hospital Charge Code |
1170123
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| 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 |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| 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 |
$19.48
|
| 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 Elbow 2 Views Right
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 RT
|
| Hospital Charge Code |
1170123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$277.95 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
|
|
XR Elbow 2 Views Right
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73070 RT
|
| Hospital Charge Code |
1170123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: AlohaCare Medicaid |
$163.50
|
| Rate for Payer: AlohaCare Medicare |
$163.50
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Devoted Health Medicare |
$179.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.65
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Humana Medicare |
$163.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.50
|
| Rate for Payer: MDX Hawaii PPO |
$317.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
XR Elbow 2 Views Right - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73070 26,RT
|
| Hospital Charge Code |
630688
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
|
|
XR Elbow Complete 3+ Views Bilateral
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 50
|
| Hospital Charge Code |
1170125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: AlohaCare Medicaid |
$262.50
|
| Rate for Payer: AlohaCare Medicare |
$262.50
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Devoted Health Medicare |
$288.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$498.75
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Humana Medicare |
$262.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.41
|
|
|
XR Elbow Complete 3+ Views Bilateral
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 50
|
| Hospital Charge Code |
1170125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
|
|
XR Elbow Complete 3+ Views Bilateral - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73080 26,50
|
| Hospital Charge Code |
630686
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
|
|
XR Elbow Complete 3+ Views Left
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 LT
|
| Hospital Charge Code |
1170127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
|
|
XR Elbow Complete 3+ Views Left
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 LT
|
| Hospital Charge Code |
1170127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: AlohaCare Medicaid |
$262.50
|
| Rate for Payer: AlohaCare Medicare |
$262.50
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Devoted Health Medicare |
$288.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$498.75
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Humana Medicare |
$262.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.41
|
|
|
XR Elbow Complete 3+ Views Left
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 73080 LT
|
| Hospital Charge Code |
1170127
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| 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 |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| 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 |
$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 |
$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 |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| 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 Elbow Complete 3+ Views Left - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73080 26,LT
|
| Hospital Charge Code |
630684
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
|
|
XR Elbow Complete 3+ Views Right
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 RT
|
| Hospital Charge Code |
1170129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
|
