|
XR Hip 4+ Views Left - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73503 26,LT
|
| Hospital Charge Code |
7520596
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$40.27
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.27
|
|
|
XR Hip 4+ Views Right
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 73503 RT
|
| Hospital Charge Code |
7520597
|
|
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
|
|
|
XR Hip 4+ Views Right
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 73503 RT
|
| Hospital Charge Code |
7520597
|
|
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 Right - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73503 26,RT
|
| Hospital Charge Code |
7520599
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$40.27
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.27
|
|
|
XR Hips 2 Views Bilat
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
7520606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$648.93 |
| Rate for Payer: AlohaCare Medicaid |
$334.50
|
| Rate for Payer: AlohaCare Medicare |
$334.50
|
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Devoted Health Medicare |
$367.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$568.65
|
| Rate for Payer: Humana Medicare |
$334.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$341.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.50
|
| Rate for Payer: MDX Hawaii PPO |
$648.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$334.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.40
|
|
|
XR Hips 2 Views Bilat
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
7520606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$648.93 |
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Health Management Network Commercial |
$568.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.10
|
| Rate for Payer: MDX Hawaii PPO |
$648.93
|
|
|
XR Hips 2 Views Bilat
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
7520606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$46.14
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Devoted Health Medicare |
$50.75
|
| 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 |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.37
|
| 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 Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| 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 |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.14
|
| 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 Hips 2 Views Bilat - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73521 26
|
| Hospital Charge Code |
7520608
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
XR Hips 3-4 Views Bilat
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
7520612
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$36.08
|
| Rate for Payer: AlohaCare Medicare |
$60.06
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$66.07
|
| 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 |
$54.76
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.07
|
| 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 |
$36.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.06
|
| 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 Hips 3-4 Views Bilat
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
7520612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$648.93 |
| Rate for Payer: AlohaCare Medicaid |
$334.50
|
| Rate for Payer: AlohaCare Medicare |
$334.50
|
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Devoted Health Medicare |
$367.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$568.65
|
| Rate for Payer: Humana Medicare |
$334.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$341.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.50
|
| Rate for Payer: MDX Hawaii PPO |
$648.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$334.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.50
|
| Rate for Payer: University Health Alliance Commercial |
$101.31
|
|
|
XR Hips 3-4 Views Bilat
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
7520612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$648.93 |
| Rate for Payer: Cash Price |
$434.85
|
| Rate for Payer: Health Management Network Commercial |
$568.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.10
|
| Rate for Payer: MDX Hawaii PPO |
$648.93
|
|
|
XR Hips 3-4 Views Bilat - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73522 26
|
| Hospital Charge Code |
7520614
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$36.08
|
| Rate for Payer: AlohaCare Medicare |
$14.30
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$15.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.76
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.30
|
|
|
XR Hips 5+ Views Bilat
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
7520618
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$657.05 |
| Max. Negotiated Rate |
$749.81 |
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Health Management Network Commercial |
$657.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.70
|
| Rate for Payer: MDX Hawaii PPO |
$749.81
|
|
|
XR Hips 5+ Views Bilat
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
7520618
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$749.81 |
| Rate for Payer: AlohaCare Medicaid |
$386.50
|
| Rate for Payer: AlohaCare Medicare |
$386.50
|
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Devoted Health Medicare |
$425.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$386.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$657.05
|
| Rate for Payer: Humana Medicare |
$386.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$386.50
|
| Rate for Payer: MDX Hawaii PPO |
$749.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$386.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$386.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$386.50
|
| Rate for Payer: University Health Alliance Commercial |
$118.03
|
|
|
XR Hips 5+ Views Bilat - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73523 26
|
| Hospital Charge Code |
7520620
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$41.41
|
| Rate for Payer: AlohaCare Medicare |
$14.96
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$16.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.80
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.96
|
|
|
XR Humerus Bilat
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 50
|
| Hospital Charge Code |
8211785
|
|
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 Humerus Bilat
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 50
|
| Hospital Charge Code |
8211785
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.20
|
|
|
XR Humerus Bilat - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73060 26,50
|
| Hospital Charge Code |
8211787
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
|
|
XR Humerus Left
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 LT
|
| Hospital Charge Code |
1170245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.20
|
|
|
XR Humerus Left
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 LT
|
| Hospital Charge Code |
1170245
|
|
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 Humerus Left
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 73060 LT
|
| Hospital Charge Code |
1170245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| 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 |
$21.32
|
| 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 Humerus Left - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73060 26,LT
|
| Hospital Charge Code |
630430
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
|
|
XR Humerus Right
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 RT
|
| Hospital Charge Code |
1170247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$61.20
|
|
|
XR Humerus Right
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 73060 RT
|
| Hospital Charge Code |
1170247
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| 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 |
$21.32
|
| 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 Humerus Right
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73060 RT
|
| Hospital Charge Code |
1170247
|
|
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
|
|
