|
XR Finger(s) 2+ Views Right
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 73140 RT
|
| Hospital Charge Code |
8111108
|
|
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 Right
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 73140 RT
|
| Hospital Charge Code |
1170153
|
|
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 - Report
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 73140 RT,26
|
| Hospital Charge Code |
8111109
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: AlohaCare Medicaid |
$25.77
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| 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 |
$25.75
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| 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 |
$25.77
|
| 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 |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Finger(s) 2+ Views Right - Report
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 73140 RT,26
|
| Hospital Charge Code |
8111109
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.77 |
| Rate for Payer: AlohaCare Medicaid |
$25.77
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.75
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.77
|
|
|
XR Fistula or Sinus Tract Abscess Study
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
8128206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
|
|
XR Fistula or Sinus Tract Abscess Study
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
8128206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: AlohaCare Medicaid |
$544.50
|
| Rate for Payer: AlohaCare Medicare |
$544.50
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Devoted Health Medicare |
$598.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$544.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.25
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Humana Medicare |
$544.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$544.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$544.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$544.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$544.50
|
| Rate for Payer: University Health Alliance Commercial |
$130.89
|
|
|
XR Fistula or Sinus Tract Abscess Study - Report
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 76080 26
|
| Hospital Charge Code |
8128207
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$24.17
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Devoted Health Medicare |
$26.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.17
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
1170173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
1170173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: AlohaCare Medicaid |
$255.00
|
| Rate for Payer: AlohaCare Medicare |
$255.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Devoted Health Medicare |
$280.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Humana Medicare |
$255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.00
|
| Rate for Payer: University Health Alliance Commercial |
$131.42
|
|
|
XR Fluoro Guidance Needle Loc Spine - Report
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Hospital Charge Code |
630592
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$28.83
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$31.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.83
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
1170175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: AlohaCare Medicaid |
$271.50
|
| Rate for Payer: AlohaCare Medicare |
$271.50
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Devoted Health Medicare |
$298.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$271.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$515.85
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Humana Medicare |
$271.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$271.50
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$271.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$271.50
|
| Rate for Payer: University Health Alliance Commercial |
$146.61
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
1170175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$461.55 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$488.70
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
|
|
XR Fluoro Guidance Needle Placement - Report
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 77002 26
|
| Hospital Charge Code |
630588
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: AlohaCare Medicaid |
$77.78
|
| Rate for Payer: AlohaCare Medicare |
$27.78
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Devoted Health Medicare |
$30.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.78
|
|
|
XR Fluoro Guide CVA Placement
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
8128535
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$517.98 |
| Rate for Payer: AlohaCare Medicaid |
$267.00
|
| Rate for Payer: AlohaCare Medicare |
$267.00
|
| Rate for Payer: Cash Price |
$347.10
|
| Rate for Payer: Cash Price |
$347.10
|
| Rate for Payer: Devoted Health Medicare |
$293.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$267.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.30
|
| Rate for Payer: Health Management Network Commercial |
$453.90
|
| Rate for Payer: Humana Medicare |
$267.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.00
|
| Rate for Payer: MDX Hawaii PPO |
$517.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$267.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$267.00
|
| Rate for Payer: University Health Alliance Commercial |
$195.54
|
|
|
XR Fluoro Guide CVA Placement
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
8128535
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$453.90 |
| Max. Negotiated Rate |
$517.98 |
| Rate for Payer: Cash Price |
$347.10
|
| Rate for Payer: Health Management Network Commercial |
$453.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.60
|
| Rate for Payer: MDX Hawaii PPO |
$517.98
|
|
|
XR Fluoroscopy Under 1 Hour EO
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
8111113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$674.90 |
| Max. Negotiated Rate |
$770.18 |
| Rate for Payer: Cash Price |
$516.10
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$714.60
|
| Rate for Payer: MDX Hawaii PPO |
$770.18
|
|
|
XR Fluoroscopy Under 1 Hour EO
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
8111113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$770.18 |
| Rate for Payer: AlohaCare Medicaid |
$397.00
|
| Rate for Payer: AlohaCare Medicare |
$397.00
|
| Rate for Payer: Cash Price |
$516.10
|
| Rate for Payer: Cash Price |
$516.10
|
| Rate for Payer: Devoted Health Medicare |
$436.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$397.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
| Rate for Payer: Humana Medicare |
$397.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$714.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$404.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.00
|
| Rate for Payer: MDX Hawaii PPO |
$770.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$397.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$397.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$397.00
|
| Rate for Payer: University Health Alliance Commercial |
$179.71
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73620 50
|
| Hospital Charge Code |
1170183
|
|
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 |
$30.36
|
| 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 |
$19.02
|
| 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 Foot 2 Views Bilateral
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73620 50
|
| Hospital Charge Code |
1170183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: AlohaCare Medicaid |
$220.00
|
| Rate for Payer: AlohaCare Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Devoted Health Medicare |
$242.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$418.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73620 50
|
| Hospital Charge Code |
1170183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
|
|
XR Foot 2 Views Bilateral - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73620 26,50
|
| Hospital Charge Code |
630566
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
|
|
XR Foot 2 Views Left
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73620 LT
|
| Hospital Charge Code |
1170185
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: AlohaCare Medicaid |
$220.00
|
| Rate for Payer: AlohaCare Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Devoted Health Medicare |
$242.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$418.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73620 LT
|
| Hospital Charge Code |
1170185
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 73620 LT
|
| Hospital Charge Code |
1170185
|
|
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 |
$30.36
|
| 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 Foot 2 Views Left - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73620 26,LT
|
| Hospital Charge Code |
630560
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
|
