|
XR Knee 1 or 2 Views Right - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73560 26,RT
|
| Hospital Charge Code |
630357
|
|
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 3 Views Bilateral
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73562 50
|
| Hospital Charge Code |
1170267
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: 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 |
$35.40
|
| 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 |
$27.46
|
| 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 3 Views Bilateral
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 50
|
| Hospital Charge Code |
1170267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.32
|
|
|
XR Knee 3 Views Bilateral
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 50
|
| Hospital Charge Code |
1170267
|
|
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 Knee 3 Views Bilateral - Report
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73562 26,50
|
| Hospital Charge Code |
630416
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
|
|
XR Knee 3 Views Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73562 LT
|
| Hospital Charge Code |
1170269
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: 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 |
$35.40
|
| 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 |
$27.46
|
| 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 3 Views Left
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 LT
|
| Hospital Charge Code |
1170269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.32
|
|
|
XR Knee 3 Views Left
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 LT
|
| Hospital Charge Code |
1170269
|
|
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 Knee 3 Views Left - Report
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73562 26,LT
|
| Hospital Charge Code |
630404
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
|
|
XR Knee 3 Views Right
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 RT
|
| Hospital Charge Code |
1170271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.32
|
|
|
XR Knee 3 Views Right
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73562 RT
|
| Hospital Charge Code |
1170271
|
|
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 Knee 3 Views Right
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 73562 RT
|
| Hospital Charge Code |
1170271
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| 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 |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| 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 |
$27.46
|
| 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 3 Views Right - Report
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73562 26,RT
|
| Hospital Charge Code |
630396
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
|
|
XR Knee Complete 4+ Views Bilateral
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
HCPCS 73564 50
|
| Hospital Charge Code |
1170285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$833.23 |
| Rate for Payer: AlohaCare Medicaid |
$429.50
|
| Rate for Payer: AlohaCare Medicare |
$429.50
|
| Rate for Payer: Cash Price |
$558.35
|
| Rate for Payer: Cash Price |
$558.35
|
| Rate for Payer: Devoted Health Medicare |
$472.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$816.05
|
| Rate for Payer: Health Management Network Commercial |
$730.15
|
| Rate for Payer: Humana Medicare |
$429.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$773.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$438.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$429.50
|
| Rate for Payer: MDX Hawaii PPO |
$833.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
XR Knee Complete 4+ Views Bilateral
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 73564 50
|
| Hospital Charge Code |
1170285
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| 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 |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| 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 |
$31.70
|
| 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 Complete 4+ Views Bilateral
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
HCPCS 73564 50
|
| Hospital Charge Code |
1170285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.15 |
| Max. Negotiated Rate |
$833.23 |
| Rate for Payer: Cash Price |
$558.35
|
| Rate for Payer: Health Management Network Commercial |
$730.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$773.10
|
| Rate for Payer: MDX Hawaii PPO |
$833.23
|
|
|
XR Knee Complete 4+ Views Bilateral - Report
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 73564 26,50
|
| Hospital Charge Code |
630392
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
|
|
XR Knee Complete 4+ Views Left
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
HCPCS 73564 LT
|
| Hospital Charge Code |
1170287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$838.08 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Health Management Network Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$777.60
|
| Rate for Payer: MDX Hawaii PPO |
$838.08
|
|
|
XR Knee Complete 4+ Views Left
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 73564 LT
|
| Hospital Charge Code |
1170287
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| 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 |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| 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 |
$31.70
|
| 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 Complete 4+ Views Left
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS 73564 LT
|
| Hospital Charge Code |
1170287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$838.08 |
| Rate for Payer: AlohaCare Medicaid |
$432.00
|
| Rate for Payer: AlohaCare Medicare |
$432.00
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Devoted Health Medicare |
$475.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$432.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$820.80
|
| Rate for Payer: Health Management Network Commercial |
$734.40
|
| Rate for Payer: Humana Medicare |
$432.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$777.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.00
|
| Rate for Payer: MDX Hawaii PPO |
$838.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$432.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$432.00
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
XR Knee Complete 4+ Views Left - Report
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 73564 26,LT
|
| Hospital Charge Code |
630374
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
|
|
XR Knee Complete 4+ Views Right
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
HCPCS 73564 RT
|
| Hospital Charge Code |
1170289
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$838.08 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Health Management Network Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$777.60
|
| Rate for Payer: MDX Hawaii PPO |
$838.08
|
|
|
XR Knee Complete 4+ Views Right
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 73564 RT
|
| Hospital Charge Code |
1170289
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| 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 |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| 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 |
$31.70
|
| 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 Complete 4+ Views Right
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS 73564 RT
|
| Hospital Charge Code |
1170289
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$838.08 |
| Rate for Payer: AlohaCare Medicaid |
$432.00
|
| Rate for Payer: AlohaCare Medicare |
$432.00
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Devoted Health Medicare |
$475.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$432.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$820.80
|
| Rate for Payer: Health Management Network Commercial |
$734.40
|
| Rate for Payer: Humana Medicare |
$432.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$777.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.00
|
| Rate for Payer: MDX Hawaii PPO |
$838.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$432.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$432.00
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
XR Knee Complete 4+ Views Right - Report
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 73564 26,RT
|
| Hospital Charge Code |
630370
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
|
