|
XR Hand Complete 3+ Views Left
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 LT
|
| Hospital Charge Code |
1170221
|
|
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 Left
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 73130 LT
|
| Hospital Charge Code |
1170221
|
|
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 Left
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 LT
|
| Hospital Charge Code |
1170221
|
|
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 Left - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73130 26,LT
|
| Hospital Charge Code |
630480
|
|
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
|
|
|
XR Hand Complete 3+ Views Right
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 73130 RT
|
| Hospital Charge Code |
1170223
|
|
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 Right
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 RT
|
| Hospital Charge Code |
1170223
|
|
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 Right
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73130 RT
|
| Hospital Charge Code |
1170223
|
|
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 Right - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73130 26,RT
|
| Hospital Charge Code |
630475
|
|
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
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: AlohaCare Medicaid |
$203.00
|
| Rate for Payer: AlohaCare Medicare |
$203.00
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$223.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.70
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Humana Medicare |
$203.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.00
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.27
|
|
|
XR Hip 1 View Left
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
|
|
XR Hip 1 View Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73501 LT
|
| Hospital Charge Code |
1170225
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.95
|
| 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 |
$33.12
|
| 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 |
$21.95
|
| 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 Hip 1 View Left - Report
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 73501 26,LT
|
| Hospital Charge Code |
630470
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.12
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.95
|
|
|
XR Hip 1 View Right
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 73501 RT
|
| Hospital Charge Code |
1170227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
|
|
XR Hip 1 View Right
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 73501 RT
|
| Hospital Charge Code |
1170227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: AlohaCare Medicaid |
$203.00
|
| Rate for Payer: AlohaCare Medicare |
$203.00
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$223.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.70
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Humana Medicare |
$203.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.00
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.27
|
|
|
XR Hip 1 View Right - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73501 26,RT
|
| Hospital Charge Code |
630466
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.95
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.12
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.95
|
|
|
XR Hip 2-3 Views Left
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 73502 LT
|
| Hospital Charge Code |
7520582
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| 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 |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| 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 |
$31.93
|
| 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 Hip 2-3 Views Left
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 73502 LT
|
| Hospital Charge Code |
7520582
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: AlohaCare Medicaid |
$203.00
|
| Rate for Payer: AlohaCare Medicare |
$203.00
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$223.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.70
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Humana Medicare |
$203.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.00
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.00
|
| Rate for Payer: University Health Alliance Commercial |
$86.21
|
|
|
XR Hip 2-3 Views Left
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 73502 LT
|
| Hospital Charge Code |
7520582
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
|
|
XR Hip 2-3 Views Left - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73502 26,LT
|
| Hospital Charge Code |
7520584
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
|
|
XR Hip 2-3 Views Right
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 73502 RT
|
| Hospital Charge Code |
7520585
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: AlohaCare Medicaid |
$203.00
|
| Rate for Payer: AlohaCare Medicare |
$203.00
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$223.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.70
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Humana Medicare |
$203.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.00
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.00
|
| Rate for Payer: University Health Alliance Commercial |
$86.21
|
|
|
XR Hip 2-3 Views Right
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 73502 RT
|
| Hospital Charge Code |
7520585
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.40
|
| Rate for Payer: MDX Hawaii PPO |
$393.82
|
|
|
XR Hip 2-3 Views Right
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 73502 RT
|
| Hospital Charge Code |
7520585
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| 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 |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| 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 |
$31.93
|
| 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 Hip 2-3 Views Right - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73502 26,RT
|
| Hospital Charge Code |
7520587
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
|
|
XR Hip 4+ Views Left
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 73503 LT
|
| Hospital Charge Code |
7520594
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: AlohaCare Medicaid |
$304.50
|
| Rate for Payer: AlohaCare Medicare |
$304.50
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Devoted Health Medicare |
$334.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$304.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$578.55
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Humana Medicare |
$304.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$310.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.50
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$304.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$304.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$304.50
|
| Rate for Payer: University Health Alliance Commercial |
$123.25
|
|
|
XR Hip 4+ Views Left
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 73503 LT
|
| Hospital Charge Code |
7520594
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$517.65 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
|
