Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Femur 1 View Left - Report

Professional

Both

$121.00

Service Code	HCPCS 73551 26,LT
Hospital Charge Code	7520566
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	$31.16
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 Femur 1 View Right

Facility

$398.00

Service Code	HCPCS 73551 RT
Hospital Charge Code	7520567
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

XR Femur 1 View Right

Facility

$398.00

Service Code	HCPCS 73551 RT
Hospital Charge Code	7520567
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 Right - Report

Professional

Both

$121.00

Service Code	HCPCS 73551 26,RT
Hospital Charge Code	7520569
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	$31.16
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 Femur 2 Views Left

Facility

$438.00

Service Code	HCPCS 73552 LT
Hospital Charge Code	7520570
Hospital Revenue Code	320
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$219.00
Rate for Payer: Cash Price	$284.70
Rate for Payer: Cash Price	$284.70
Rate for Payer: Devoted Health Medicare	$240.90
Rate for Payer: Hawaii Medical Service Association ABD	$15.87
Rate for Payer: Hawaii Medical Service Association Medicare	$219.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.67
Rate for Payer: Hawaii Western Management Group Commercial	$416.10
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$219.00
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$219.00
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$219.00
Rate for Payer: Ohana Health Plan Medicare	$219.00
Rate for Payer: UnitedHealthcare Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicare	$219.00
Rate for Payer: University Health Alliance Commercial	$67.43

XR Femur 2 Views Left

Professional

Both

$179.00

Service Code	HCPCS 73552 LT
Hospital Charge Code	7520570
Hospital Revenue Code	521
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$434.26
Rate for Payer: AlohaCare Medicaid	$23.78
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
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	$36.46
Rate for Payer: Health Management Network Commercial	$152.15
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	$23.78
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 Femur 2 Views Left

Facility

$438.00

Service Code	HCPCS 73552 LT
Hospital Charge Code	7520570
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

XR Femur 2 Views Left - Report

Professional

Both

$121.00

Service Code	HCPCS 73552 26,LT
Hospital Charge Code	7520572
Hospital Revenue Code	972
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$23.78
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$36.46
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicaid	$23.78

XR Femur 2 Views Right

Facility

$438.00

Service Code	HCPCS 73552 RT
Hospital Charge Code	7520573
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

XR Femur 2 Views Right

Facility

$438.00

Service Code	HCPCS 73552 RT
Hospital Charge Code	7520573
Hospital Revenue Code	320
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$219.00
Rate for Payer: Cash Price	$284.70
Rate for Payer: Cash Price	$284.70
Rate for Payer: Devoted Health Medicare	$240.90
Rate for Payer: Hawaii Medical Service Association ABD	$15.87
Rate for Payer: Hawaii Medical Service Association Medicare	$219.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.67
Rate for Payer: Hawaii Western Management Group Commercial	$416.10
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$219.00
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$219.00
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$219.00
Rate for Payer: Ohana Health Plan Medicare	$219.00
Rate for Payer: UnitedHealthcare Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicare	$219.00
Rate for Payer: University Health Alliance Commercial	$67.43

XR Femur 2 Views Right

Professional

Both

$179.00

Service Code	HCPCS 73552 RT
Hospital Charge Code	7520573
Hospital Revenue Code	521
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$434.26
Rate for Payer: AlohaCare Medicaid	$23.78
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
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	$36.46
Rate for Payer: Health Management Network Commercial	$152.15
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	$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: Kaiser Permanente Medicare	$265.97
Rate for Payer: Kaiser Permanente Medicare	$339.46
Rate for Payer: Ohana Health Plan Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicaid	$434.26
Rate for Payer: UnitedHealthcare Medicare	$209.49
Rate for Payer: UnitedHealthcare Medicare	$181.39
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 Femur 2 Views Right - Report

Professional

Both

$121.00

Service Code	HCPCS 73552 26,RT
Hospital Charge Code	7520575
Hospital Revenue Code	972
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$23.78
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$36.46
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicaid	$23.78

XR Fine Needle Aspiration w/ Guidance

Facility

$2,665.00

Service Code	HCPCS 10007 TC
Hospital Charge Code	8418227
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,332.50
Rate for Payer: AlohaCare Medicare	$1,332.50
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Devoted Health Medicare	$1,465.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,332.50
Rate for Payer: Health Management Network Commercial	$2,265.25
Rate for Payer: Humana Medicare	$1,332.50
Rate for Payer: Kaiser Permanente Commercial	$2,398.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,332.50
Rate for Payer: MDX Hawaii PPO	$2,585.05
Rate for Payer: Ohana Health Plan Medicaid	$1,332.50
Rate for Payer: Ohana Health Plan Medicare	$1,332.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,332.50
Rate for Payer: University Health Alliance Commercial	$1,492.40

XR Fine Needle Aspiration w/ Guidance

Facility

$2,665.00

Service Code	HCPCS 10007 TC
Hospital Charge Code	8418227
Hospital Revenue Code	361
Min. Negotiated Rate	$2,265.25
Max. Negotiated Rate	$2,585.05
Rate for Payer: Cash Price	$1,732.25
Rate for Payer: Health Management Network Commercial	$2,265.25
Rate for Payer: Kaiser Permanente Commercial	$2,398.50
Rate for Payer: MDX Hawaii PPO	$2,585.05

XR Finger(1st Digit) 2+ Views Left

Facility

$325.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	7998587
Hospital Revenue Code	320
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

XR Finger(1st Digit) 2+ Views Left

Facility

$325.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	7998587
Hospital Revenue Code	320
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$162.50
Rate for Payer: Cash Price	$211.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Devoted Health Medicare	$178.75
Rate for Payer: Hawaii Medical Service Association ABD	$14.98
Rate for Payer: Hawaii Medical Service Association Medicare	$162.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.73
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$162.50
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$162.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$162.50
Rate for Payer: Ohana Health Plan Medicare	$162.50
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: UnitedHealthcare Medicare	$162.50
Rate for Payer: University Health Alliance Commercial	$54.96

XR Finger(1st Digit) 2+ Views Left - Report

Professional

Both

$121.00

Service Code	HCPCS 73140 26,LT
Hospital Charge Code	7998589
Hospital Revenue Code	972
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$25.77
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.75
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$25.77
Rate for Payer: UnitedHealthcare Medicaid	$25.77

XR Finger(1st Digit) 2+ Views Right

Facility

$325.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	7998590
Hospital Revenue Code	320
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

XR Finger(1st Digit) 2+ Views Right

Facility

$325.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	7998590
Hospital Revenue Code	320
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$162.50
Rate for Payer: Cash Price	$211.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Devoted Health Medicare	$178.75
Rate for Payer: Hawaii Medical Service Association ABD	$14.98
Rate for Payer: Hawaii Medical Service Association Medicare	$162.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.73
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$162.50
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$162.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$162.50
Rate for Payer: Ohana Health Plan Medicare	$162.50
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: UnitedHealthcare Medicare	$162.50
Rate for Payer: University Health Alliance Commercial	$54.96

XR Finger(1st Digit) 2+ Views Right - Report

Professional

Both

$121.00

Service Code	HCPCS 73140 26,RT
Hospital Charge Code	7998592
Hospital Revenue Code	972
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$25.77
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.75
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$25.77
Rate for Payer: UnitedHealthcare Medicaid	$25.77

XR Finger(s) 2+ Views Left

Facility

$325.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	8111106
Hospital Revenue Code	320
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

XR Finger(s) 2+ Views Left

Facility

$325.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	8111106
Hospital Revenue Code	320
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$162.50
Rate for Payer: Cash Price	$211.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Devoted Health Medicare	$178.75
Rate for Payer: Hawaii Medical Service Association ABD	$14.98
Rate for Payer: Hawaii Medical Service Association Medicare	$162.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.73
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$162.50
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$162.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$162.50
Rate for Payer: Ohana Health Plan Medicare	$162.50
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: UnitedHealthcare Medicare	$162.50
Rate for Payer: University Health Alliance Commercial	$54.96

XR Finger(s) 2+ Views Left - Report

Professional

Both

$121.00

Service Code	HCPCS 73140 LT,26
Hospital Charge Code	8111107
Hospital Revenue Code	972
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$25.77
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.75
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$25.77
Rate for Payer: UnitedHealthcare Medicaid	$25.77

XR Finger(s) 2+ Views Right

Facility

$325.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	8111108
Hospital Revenue Code	320
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$162.50
Rate for Payer: Cash Price	$211.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Devoted Health Medicare	$178.75
Rate for Payer: Hawaii Medical Service Association ABD	$14.98
Rate for Payer: Hawaii Medical Service Association Medicare	$162.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.73
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$162.50
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$162.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$162.50
Rate for Payer: Ohana Health Plan Medicare	$162.50
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: UnitedHealthcare Medicare	$162.50
Rate for Payer: University Health Alliance Commercial	$54.96

XR Finger(s) 2+ Views Right

Facility

$325.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	1170153
Hospital Revenue Code	320
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

Know your out-of-pocket cost for care.

All Charges