|
XR Humerus Right - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73060 26,RT
|
| Hospital Charge Code |
630428
|
|
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 Hysterosalpingography
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
1170249
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$907.80 |
| Max. Negotiated Rate |
$1,035.96 |
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Health Management Network Commercial |
$907.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$961.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,035.96
|
|
|
XR Hysterosalpingography
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
1170249
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$1,035.96 |
| Rate for Payer: AlohaCare Medicaid |
$534.00
|
| Rate for Payer: AlohaCare Medicare |
$534.00
|
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Devoted Health Medicare |
$587.40
|
| 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 |
$534.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$907.80
|
| Rate for Payer: Humana Medicare |
$534.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$961.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$544.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$534.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,035.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$534.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$534.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$534.00
|
| Rate for Payer: University Health Alliance Commercial |
$156.07
|
|
|
XR Hysterosalpingography - Report
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 74740 26
|
| Hospital Charge Code |
630426
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$18.06
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$19.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.76
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.06
|
|
|
XR Insertion Straight Bladder Catheter
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
2425542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.15 |
| Max. Negotiated Rate |
$1,240.63 |
| Rate for Payer: Cash Price |
$831.35
|
| Rate for Payer: Health Management Network Commercial |
$1,087.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,151.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,240.63
|
|
|
XR Insertion Straight Bladder Catheter
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
2425542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$639.50
|
| Rate for Payer: AlohaCare Medicare |
$639.50
|
| Rate for Payer: Cash Price |
$831.35
|
| Rate for Payer: Cash Price |
$831.35
|
| Rate for Payer: Cash Price |
$831.35
|
| Rate for Payer: Devoted Health Medicare |
$703.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$904.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$639.50
|
| Rate for Payer: Health Management Network Commercial |
$1,087.15
|
| Rate for Payer: Humana Medicare |
$639.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,151.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$639.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,240.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$639.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$639.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$639.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Left
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 20610 LT
|
| Hospital Charge Code |
2425554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$353.50
|
| Rate for Payer: AlohaCare Medicare |
$353.50
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Devoted Health Medicare |
$388.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$353.50
|
| Rate for Payer: Health Management Network Commercial |
$600.95
|
| Rate for Payer: Humana Medicare |
$353.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$353.50
|
| Rate for Payer: MDX Hawaii PPO |
$685.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$353.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$353.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$353.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Left
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 20610 LT
|
| Hospital Charge Code |
2425554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.95 |
| Max. Negotiated Rate |
$685.79 |
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Health Management Network Commercial |
$600.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.30
|
| Rate for Payer: MDX Hawaii PPO |
$685.79
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Left - Report
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20610 26,LT
|
| Hospital Charge Code |
2425556
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$45.55 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: AlohaCare Medicaid |
$45.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.76
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.55
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Right
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 20610 RT
|
| Hospital Charge Code |
2425557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.95 |
| Max. Negotiated Rate |
$685.79 |
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Health Management Network Commercial |
$600.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.30
|
| Rate for Payer: MDX Hawaii PPO |
$685.79
|
|
|
XR Joint/Bursa Major Arthr/Asp/Inj Right
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 20610 RT
|
| Hospital Charge Code |
2425557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$353.50
|
| Rate for Payer: AlohaCare Medicare |
$353.50
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Cash Price |
$459.55
|
| Rate for Payer: Devoted Health Medicare |
$388.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$353.50
|
| Rate for Payer: Health Management Network Commercial |
$600.95
|
| Rate for Payer: Humana Medicare |
$353.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$353.50
|
| Rate for Payer: MDX Hawaii PPO |
$685.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$353.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$353.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$353.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
XR Joint Survey Single View 2+ Joints
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
HCPCS 77077
|
| Hospital Charge Code |
1170259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.15 |
| Max. Negotiated Rate |
$406.43 |
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Health Management Network Commercial |
$356.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$377.10
|
| Rate for Payer: MDX Hawaii PPO |
$406.43
|
|
|
XR Joint Survey Single View 2+ Joints
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
HCPCS 77077
|
| Hospital Charge Code |
1170259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$406.43 |
| Rate for Payer: AlohaCare Medicaid |
$209.50
|
| Rate for Payer: AlohaCare Medicare |
$209.50
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Devoted Health Medicare |
$230.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$356.15
|
| Rate for Payer: Humana Medicare |
$209.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$377.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.50
|
| Rate for Payer: MDX Hawaii PPO |
$406.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.50
|
| Rate for Payer: University Health Alliance Commercial |
$97.64
|
|
|
XR Joint Survey Single View 2+ Joints - Report
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 77077 26
|
| Hospital Charge Code |
630412
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: AlohaCare Medicaid |
$31.02
|
| Rate for Payer: AlohaCare Medicare |
$16.77
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$18.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.77
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.77
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73560 50
|
| Hospital Charge Code |
1170261
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| 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 |
$32.16
|
| 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 |
$22.93
|
| 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 Knee 1 or 2 Views Bilateral
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 50
|
| Hospital Charge Code |
1170261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.25 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 50
|
| Hospital Charge Code |
1170261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: AlohaCare Medicaid |
$282.50
|
| Rate for Payer: AlohaCare Medicare |
$282.50
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Devoted Health Medicare |
$310.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$536.75
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Humana Medicare |
$282.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.50
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Knee 1 or 2 Views Bilateral - Report
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 73560 26,50
|
| Hospital Charge Code |
630366
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.16
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 LT
|
| Hospital Charge Code |
1170263
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: AlohaCare Medicaid |
$282.50
|
| Rate for Payer: AlohaCare Medicare |
$282.50
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Devoted Health Medicare |
$310.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$536.75
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Humana Medicare |
$282.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.50
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73560 LT
|
| Hospital Charge Code |
1170263
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| 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 |
$32.16
|
| 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 |
$22.93
|
| 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 Knee 1 or 2 Views Left
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 LT
|
| Hospital Charge Code |
1170263
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.25 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
|
|
XR Knee 1 or 2 Views Left - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73560 26,LT
|
| Hospital Charge Code |
630362
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.16
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 RT
|
| Hospital Charge Code |
1170265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: AlohaCare Medicaid |
$282.50
|
| Rate for Payer: AlohaCare Medicare |
$282.50
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Devoted Health Medicare |
$310.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$536.75
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Humana Medicare |
$282.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.50
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73560 RT
|
| Hospital Charge Code |
1170265
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| 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 |
$32.16
|
| 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 |
$22.93
|
| 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 Knee 1 or 2 Views Right
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 73560 RT
|
| Hospital Charge Code |
1170265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.25 |
| Max. Negotiated Rate |
$548.05 |
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$508.50
|
| Rate for Payer: MDX Hawaii PPO |
$548.05
|
|
