|
XR Mastoids Complete - Report
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 70120 26,50
|
| Hospital Charge Code |
630324
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$25.62
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.46
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.62
|
|
|
XR Myelogram 2 or More Regions w/ Inject
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
5182399
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.02 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: AlohaCare Medicaid |
$792.50
|
| Rate for Payer: AlohaCare Medicare |
$792.50
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Devoted Health Medicare |
$871.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$201.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,001.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$792.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$218.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.90
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Humana Medicare |
$792.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$792.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$792.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$792.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$201.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$792.50
|
| Rate for Payer: University Health Alliance Commercial |
$524.68
|
|
|
XR Myelogram 2 or More Regions w/ Inject
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
5182399
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,347.25 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
|
|
XR Myelogram 2 or More Regions w/ Inject - Report
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 72270 26
|
| Hospital Charge Code |
5182401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$100.09
|
| Rate for Payer: AlohaCare Medicare |
$61.10
|
| Rate for Payer: Cash Price |
$709.15
|
| Rate for Payer: Cash Price |
$709.15
|
| Rate for Payer: Devoted Health Medicare |
$67.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$340.81
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.10
|
|
|
XR Myelogram Cervical Spine
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
1170319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,347.25 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
|
|
XR Myelogram Cervical Spine
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
1170319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: AlohaCare Medicaid |
$792.50
|
| Rate for Payer: AlohaCare Medicare |
$792.50
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Devoted Health Medicare |
$871.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$156.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,001.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$792.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.90
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Humana Medicare |
$792.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$792.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$792.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$792.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$156.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$792.50
|
| Rate for Payer: University Health Alliance Commercial |
$375.70
|
|
|
XR Myelogram Cervical Spine - Report
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 72240 26
|
| Hospital Charge Code |
629691
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$73.58
|
| Rate for Payer: AlohaCare Medicare |
$43.80
|
| Rate for Payer: Cash Price |
$709.15
|
| Rate for Payer: Cash Price |
$709.15
|
| Rate for Payer: Devoted Health Medicare |
$48.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.70
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.80
|
|
|
XR Myelogram Injection
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
2425581
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$488.88 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Health Management Network Commercial |
$428.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$453.60
|
| Rate for Payer: MDX Hawaii PPO |
$488.88
|
|
|
XR Myelogram Injection
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
2425581
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$252.00
|
| Rate for Payer: AlohaCare Medicare |
$252.00
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Devoted Health Medicare |
$277.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$252.00
|
| Rate for Payer: Health Management Network Commercial |
$428.40
|
| Rate for Payer: Humana Medicare |
$252.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$453.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.00
|
| Rate for Payer: MDX Hawaii PPO |
$488.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.00
|
| Rate for Payer: University Health Alliance Commercial |
$282.24
|
|
|
XR Myelogram Injection - Report
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
2425583
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$83.12
|
| Rate for Payer: AlohaCare Medicare |
$71.80
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Devoted Health Medicare |
$78.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.80
|
| Rate for Payer: University Health Alliance Commercial |
$111.87
|
|
|
XR Myelogram Lumbosacral Spine
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
1170321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: AlohaCare Medicaid |
$792.50
|
| Rate for Payer: AlohaCare Medicare |
$792.50
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Devoted Health Medicare |
$871.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,001.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$792.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$140.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.90
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Humana Medicare |
$792.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$792.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$792.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$792.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$792.50
|
| Rate for Payer: University Health Alliance Commercial |
$339.59
|
|
|
XR Myelogram Lumbosacral Spine
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
1170321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,347.25 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
|
|
XR Myelogram Lumbosacral Spine - Report
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 72265 26
|
| Hospital Charge Code |
630316
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$40.93
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Devoted Health Medicare |
$45.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.93
|
|
|
XR Myelogram Thoracic Spine
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
1170327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.62 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: AlohaCare Medicaid |
$792.50
|
| Rate for Payer: AlohaCare Medicare |
$792.50
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Devoted Health Medicare |
$871.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,001.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$792.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.90
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Humana Medicare |
$792.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$792.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$792.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$792.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$792.50
|
| Rate for Payer: University Health Alliance Commercial |
$344.53
|
|
|
XR Myelogram Thoracic Spine
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
1170327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,347.25 |
| Max. Negotiated Rate |
$1,537.45 |
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,426.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,537.45
|
|
|
XR Myelogram Thoracic Spine - Report
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 72255 26
|
| Hospital Charge Code |
630312
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: AlohaCare Medicaid |
$70.71
|
| Rate for Payer: AlohaCare Medicare |
$42.85
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Devoted Health Medicare |
$47.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.92
|
| Rate for Payer: Health Management Network Commercial |
$573.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.85
|
|
|
XR Nasal Bones 3+ Views
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
1170329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$354.45 |
| Max. Negotiated Rate |
$404.49 |
| Rate for Payer: Cash Price |
$271.05
|
| Rate for Payer: Health Management Network Commercial |
$354.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.30
|
| Rate for Payer: MDX Hawaii PPO |
$404.49
|
|
|
XR Nasal Bones 3+ Views
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
1170329
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$25.19
|
| Rate for Payer: AlohaCare Medicare |
$41.38
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Devoted Health Medicare |
$45.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| 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 Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$158.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.66
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| 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: Ohana Health Plan Medicaid |
$25.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Nasal Bones 3+ Views
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
1170329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$404.49 |
| Rate for Payer: AlohaCare Medicaid |
$208.50
|
| Rate for Payer: AlohaCare Medicare |
$208.50
|
| Rate for Payer: Cash Price |
$271.05
|
| Rate for Payer: Cash Price |
$271.05
|
| Rate for Payer: Devoted Health Medicare |
$229.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$354.45
|
| Rate for Payer: Humana Medicare |
$208.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.50
|
| Rate for Payer: MDX Hawaii PPO |
$404.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.50
|
| Rate for Payer: University Health Alliance Commercial |
$63.38
|
|
|
XR Nasal Bones 3+ Views - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 70160 26
|
| Hospital Charge Code |
630310
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$25.19
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
XR Neck Soft Tissue
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
1170331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: AlohaCare Medicaid |
$181.50
|
| Rate for Payer: AlohaCare Medicare |
$181.50
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Devoted Health Medicare |
$199.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Humana Medicare |
$181.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.50
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.50
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
XR Neck Soft Tissue
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
1170331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.55 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.70
|
| Rate for Payer: MDX Hawaii PPO |
$352.11
|
|
|
XR Neck Soft Tissue
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
1170331
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$20.80
|
| Rate for Payer: AlohaCare Medicare |
$34.12
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$37.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| 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 Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.84
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.94
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| 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: Ohana Health Plan Medicaid |
$20.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Neck Soft Tissue - Report
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 70360 26
|
| Hospital Charge Code |
630308
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$20.80
|
| Rate for Payer: AlohaCare Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$9.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.84
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
|
XR Orbits Complete
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
1170339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$473.36 |
| Rate for Payer: AlohaCare Medicaid |
$244.00
|
| Rate for Payer: AlohaCare Medicare |
$244.00
|
| Rate for Payer: Cash Price |
$317.20
|
| Rate for Payer: Cash Price |
$317.20
|
| Rate for Payer: Devoted Health Medicare |
$268.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$244.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$414.80
|
| Rate for Payer: Humana Medicare |
$244.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$439.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.00
|
| Rate for Payer: MDX Hawaii PPO |
$473.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$244.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$244.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.41
|
|
