|
XR Elbow Complete 3+ Views Right
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73080 RT
|
| Hospital Charge Code |
1170129
|
|
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 Right
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 73080 RT
|
| Hospital Charge Code |
1170129
|
|
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 |
$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 |
$21.98
|
| 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 Complete 3+ Views Right - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73080 26,RT
|
| Hospital Charge Code |
630680
|
|
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 Esophagoscopy Remove Foreign Body
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
2425452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$638.26 |
| Rate for Payer: AlohaCare Medicaid |
$329.00
|
| Rate for Payer: AlohaCare Medicare |
$329.00
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: Devoted Health Medicare |
$361.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$329.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$625.10
|
| Rate for Payer: Health Management Network Commercial |
$559.30
|
| Rate for Payer: Humana Medicare |
$329.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$592.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$335.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.00
|
| Rate for Payer: MDX Hawaii PPO |
$638.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$329.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$329.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$329.00
|
| Rate for Payer: University Health Alliance Commercial |
$368.48
|
|
|
XR Esophagoscopy Remove Foreign Body
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
2425452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$559.30 |
| Max. Negotiated Rate |
$638.26 |
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: Health Management Network Commercial |
$559.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$592.20
|
| Rate for Payer: MDX Hawaii PPO |
$638.26
|
|
|
XR Esophagoscopy Remove Foreign Body - Report
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 74235 26
|
| Hospital Charge Code |
2425454
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$179.96 |
| Rate for Payer: AlohaCare Medicaid |
$132.88
|
| Rate for Payer: AlohaCare Medicare |
$55.67
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$61.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.96
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.67
|
|
|
XR Esophagus
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
1170137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$227.00
|
| Rate for Payer: AlohaCare Medicare |
$227.00
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Devoted Health Medicare |
$249.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$227.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$227.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.00
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$227.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$227.00
|
| Rate for Payer: University Health Alliance Commercial |
$167.61
|
|
|
XR Esophagus
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
1170137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
XR Esophagus - Report
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74220 26
|
| Hospital Charge Code |
630672
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$64.75
|
| Rate for Payer: AlohaCare Medicare |
$28.26
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$31.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.11
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.26
|
|
|
XR Facet Injection Lumb/Sacr Lv1 Bilat
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
HCPCS 64493 50
|
| Hospital Charge Code |
8207978
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,144.00
|
| Rate for Payer: AlohaCare Medicare |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Devoted Health Medicare |
$1,258.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,144.00
|
| Rate for Payer: Health Management Network Commercial |
$1,944.80
|
| Rate for Payer: Humana Medicare |
$1,144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,059.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,144.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,219.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
XR Facet Injection Lumb/Sacr Lv1 Bilat
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
HCPCS 64493 50
|
| Hospital Charge Code |
8207978
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,944.80 |
| Max. Negotiated Rate |
$2,219.36 |
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Health Management Network Commercial |
$1,944.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,059.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,219.36
|
|
|
XR Facet Injection Lumb/Sacr Lv2 Bilat
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 64494 50
|
| Hospital Charge Code |
8207981
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$691.05 |
| Max. Negotiated Rate |
$788.61 |
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
|
|
XR Facet Injection Lumb/Sacr Lv2 Bilat
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 64494 50
|
| Hospital Charge Code |
8207981
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$406.50
|
| Rate for Payer: AlohaCare Medicare |
$406.50
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Devoted Health Medicare |
$447.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$406.50
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Humana Medicare |
$406.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.50
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$406.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$406.50
|
| Rate for Payer: University Health Alliance Commercial |
$455.28
|
|
|
XR Facet Injection Lumb/Sacr Lv3+ Bilat
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 64495 50
|
| Hospital Charge Code |
8207984
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$406.50
|
| Rate for Payer: AlohaCare Medicare |
$406.50
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Devoted Health Medicare |
$447.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$406.50
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Humana Medicare |
$406.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.50
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$406.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$406.50
|
| Rate for Payer: University Health Alliance Commercial |
$455.28
|
|
|
XR Facet Injection Lumb/Sacr Lv3+ Bilat
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 64495 50
|
| Hospital Charge Code |
8207984
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$691.05 |
| Max. Negotiated Rate |
$788.61 |
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
1170139
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.23
|
| Rate for Payer: AlohaCare Medicare |
$34.84
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$38.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.84
|
| 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 Facial Bones < 3 Views
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
1170139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: AlohaCare Medicaid |
$289.00
|
| Rate for Payer: AlohaCare Medicare |
$289.00
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Devoted Health Medicare |
$317.90
|
| 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 |
$289.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Humana Medicare |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.00
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.00
|
| Rate for Payer: University Health Alliance Commercial |
$64.21
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
1170139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.30 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
|
|
XR Facial Bones 3+ Views
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
1170141
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.58
|
| Rate for Payer: AlohaCare Medicare |
$51.65
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Devoted Health Medicare |
$56.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.10
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.98
|
| 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 |
$31.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.65
|
| 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 Facial Bones 3+ Views
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
1170141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$586.50 |
| Max. Negotiated Rate |
$669.30 |
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Health Management Network Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.00
|
| Rate for Payer: MDX Hawaii PPO |
$669.30
|
|
|
XR Facial Bones 3+ Views
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
1170141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$669.30 |
| Rate for Payer: AlohaCare Medicaid |
$345.00
|
| Rate for Payer: AlohaCare Medicare |
$345.00
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Devoted Health Medicare |
$379.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$345.00
|
| 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 |
$586.50
|
| Rate for Payer: Humana Medicare |
$345.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.00
|
| Rate for Payer: MDX Hawaii PPO |
$669.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$345.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$345.00
|
| Rate for Payer: University Health Alliance Commercial |
$87.39
|
|
|
XR Facial Bones < 3 Views - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70140 26
|
| Hospital Charge Code |
630668
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$21.23
|
| Rate for Payer: AlohaCare Medicare |
$9.96
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$10.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.96
|
|
|
XR Facial Bones 3+ Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 70150 26
|
| Hospital Charge Code |
630664
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$31.58
|
| Rate for Payer: AlohaCare Medicare |
$12.72
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$13.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.10
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.72
|
|
|
XR Femur 1 View Left
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS 73551 LT
|
| Hospital Charge Code |
7520564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.30 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: Cash Price |
$258.70
|
| Rate for Payer: Health Management Network Commercial |
$338.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$358.20
|
| Rate for Payer: MDX Hawaii PPO |
$386.06
|
|
|
XR Femur 1 View Left
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS 73551 LT
|
| Hospital Charge Code |
7520564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: AlohaCare Medicaid |
$199.00
|
| Rate for Payer: AlohaCare Medicare |
$199.00
|
| Rate for Payer: Cash Price |
$258.70
|
| Rate for Payer: Cash Price |
$258.70
|
| Rate for Payer: Devoted Health Medicare |
$218.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.10
|
| Rate for Payer: Health Management Network Commercial |
$338.30
|
| Rate for Payer: Humana Medicare |
$199.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$199.00
|
| Rate for Payer: MDX Hawaii PPO |
$386.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.00
|
| Rate for Payer: University Health Alliance Commercial |
$57.63
|
|
