|
XR Forearm 2 Views Right
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73090 RT
|
| Hospital Charge Code |
1170199
|
|
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 |
$31.71
|
| 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 Forearm 2 Views Right
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73090 RT
|
| Hospital Charge Code |
1170199
|
|
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 Forearm 2 Views Right - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73090 26,RT
|
| Hospital Charge Code |
630520
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.71
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
|
|
XR Foreign Body Localization Child 1 Vw
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
1170207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$391.85 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
|
|
XR Foreign Body Localization Child 1 Vw
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
1170207
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$31.46
|
| 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 |
$34.61
|
| 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 |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.75
|
| 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 |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.46
|
| 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 Foreign Body Localization Child 1 Vw
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
1170207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: AlohaCare Medicaid |
$230.50
|
| Rate for Payer: AlohaCare Medicare |
$230.50
|
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Devoted Health Medicare |
$253.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Humana Medicare |
$230.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$230.50
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.50
|
| Rate for Payer: University Health Alliance Commercial |
$57.68
|
|
|
XR Foreign Body Localization Child 1 Vw - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 76010 26
|
| Hospital Charge Code |
630504
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Devoted Health Medicare |
$9.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
|
|
XR Foreign Body Localization Eye
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 70030 50
|
| Hospital Charge Code |
1170203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$334.90 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
|
|
XR Foreign Body Localization Eye
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 70030 50
|
| Hospital Charge Code |
1170203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: AlohaCare Medicaid |
$197.00
|
| Rate for Payer: AlohaCare Medicare |
$197.00
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Devoted Health Medicare |
$216.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$374.30
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Humana Medicare |
$197.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.00
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
|
XR Foreign Body Localization Eye - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70030 26,50
|
| Hospital Charge Code |
630512
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$21.72
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.84
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.72
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 50
|
| Hospital Charge Code |
1170213
|
|
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 Hand 2 Views Bilateral
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 50
|
| Hospital Charge Code |
1170213
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
XR Hand 2 Views Bilateral - Report
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 73120 26,50
|
| Hospital Charge Code |
630500
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR Hand 2 Views Left
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 73120 LT
|
| Hospital Charge Code |
1170215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| 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 |
$141.10
|
| 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 |
$21.09
|
| 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 Hand 2 Views Left
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 LT
|
| Hospital Charge Code |
1170215
|
|
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 Hand 2 Views Left
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 LT
|
| Hospital Charge Code |
1170215
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
XR Hand 2 Views Left - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73120 26,LT
|
| Hospital Charge Code |
630494
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR Hand 2 Views Right
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 RT
|
| Hospital Charge Code |
1170217
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
XR Hand 2 Views Right
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73120 RT
|
| Hospital Charge Code |
1170217
|
|
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 Hand 2 Views Right
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 73120 RT
|
| Hospital Charge Code |
1170217
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| 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 |
$141.10
|
| 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 |
$21.09
|
| 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 Hand 2 Views Right - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73120 26,RT
|
| Hospital Charge Code |
630490
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR Hand Complete 3+ Views Bilateral
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 50
|
| Hospital Charge Code |
1170219
|
|
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 Hand Complete 3+ Views Bilateral
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 50
|
| Hospital Charge Code |
1170219
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| 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 |
$19.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.03
|
| 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 |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
XR Hand Complete 3+ Views Bilateral
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 73130 50
|
| Hospital Charge Code |
1170219
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| 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 |
$24.96
|
| 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 Hand Complete 3+ Views Bilateral - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73130 26,50
|
| Hospital Charge Code |
630484
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
|
