|
XR Sacrum/Coccyx 2+ Views
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
1170391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.75
|
| Rate for Payer: AlohaCare Medicare |
$35.31
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Devoted Health Medicare |
$38.84
|
| 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 |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.37
|
| 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 |
$21.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.31
|
| 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 Sacrum/Coccyx 2+ Views
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
1170391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$398.67 |
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
|
|
XR Sacrum/Coccyx 2+ Views
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
1170391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$398.67 |
| Rate for Payer: AlohaCare Medicaid |
$205.50
|
| Rate for Payer: AlohaCare Medicare |
$205.50
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Devoted Health Medicare |
$226.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Humana Medicare |
$205.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.50
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.50
|
| Rate for Payer: University Health Alliance Commercial |
$62.01
|
|
|
XR Sacrum/Coccyx 2+ Views - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 72220 26
|
| Hospital Charge Code |
630187
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.75
|
| 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 |
$34.64
|
| 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 |
$21.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
XR Scapula Complete Bilateral
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 50
|
| Hospital Charge Code |
8207987
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: AlohaCare Medicaid |
$262.00
|
| Rate for Payer: AlohaCare Medicare |
$262.00
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Devoted Health Medicare |
$288.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$497.80
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Humana Medicare |
$262.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.00
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.00
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Scapula Complete Bilateral
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 50
|
| Hospital Charge Code |
8207987
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
|
|
XR Scapula Complete Bilateral - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73010 26,50
|
| Hospital Charge Code |
8207989
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
|
|
XR Scapula Left
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 LT
|
| Hospital Charge Code |
1170401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
|
|
XR Scapula Left
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 LT
|
| Hospital Charge Code |
1170401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: AlohaCare Medicaid |
$262.00
|
| Rate for Payer: AlohaCare Medicare |
$262.00
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Devoted Health Medicare |
$288.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$497.80
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Humana Medicare |
$262.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.00
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.00
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Scapula Left
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73010 LT
|
| Hospital Charge Code |
1170401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.78
|
| 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 Scapula Left - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73010 26,LT
|
| Hospital Charge Code |
630167
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
|
|
XR Scapula Right
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 RT
|
| Hospital Charge Code |
1170403
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
|
|
XR Scapula Right
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 73010 RT
|
| Hospital Charge Code |
1170403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.78
|
| 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 Scapula Right
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 73010 RT
|
| Hospital Charge Code |
1170403
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$508.28 |
| Rate for Payer: AlohaCare Medicaid |
$262.00
|
| Rate for Payer: AlohaCare Medicare |
$262.00
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Devoted Health Medicare |
$288.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$497.80
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Humana Medicare |
$262.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$471.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.00
|
| Rate for Payer: MDX Hawaii PPO |
$508.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.00
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
XR Scapula Right - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73010 26,RT
|
| Hospital Charge Code |
630163
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.36
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
|
|
XR Sella Turcica
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 70240
|
| Hospital Charge Code |
1170405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: AlohaCare Medicaid |
$159.50
|
| Rate for Payer: AlohaCare Medicare |
$159.50
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$175.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.50
|
| 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 |
$271.15
|
| Rate for Payer: Humana Medicare |
$159.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.50
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.80
|
|
|
XR Sella Turcica
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 70240
|
| Hospital Charge Code |
1170405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
XR Sella Turcica - Report
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 70240 26
|
| Hospital Charge Code |
630157
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.92
|
| Rate for Payer: AlohaCare Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Devoted Health Medicare |
$10.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.95
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.20
|
|
|
XR Shoulder 1 View Left
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 73020 LT
|
| Hospital Charge Code |
1170409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: AlohaCare Medicaid |
$198.50
|
| Rate for Payer: AlohaCare Medicare |
$198.50
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Devoted Health Medicare |
$218.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.15
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Humana Medicare |
$198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.50
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.50
|
| Rate for Payer: University Health Alliance Commercial |
$49.15
|
|
|
XR Shoulder 1 View Left
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 73020 LT
|
| Hospital Charge Code |
1170409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
|
|
XR Shoulder 1 View Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73020 LT
|
| Hospital Charge Code |
1170409
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$14.24
|
| 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 |
$29.20
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 |
$14.24
|
| 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 Shoulder 1 View Left - Report
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 73020 26,LT
|
| Hospital Charge Code |
630147
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$14.24
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.20
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.24
|
|
|
XR Shoulder 1 View Right
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 73020 RT
|
| Hospital Charge Code |
1170411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: AlohaCare Medicaid |
$198.50
|
| Rate for Payer: AlohaCare Medicare |
$198.50
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Devoted Health Medicare |
$218.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.15
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Humana Medicare |
$198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.50
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.50
|
| Rate for Payer: University Health Alliance Commercial |
$49.15
|
|
|
XR Shoulder 1 View Right
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 73020 RT
|
| Hospital Charge Code |
1170411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
|
|
XR Shoulder 1 View Right
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73020 RT
|
| Hospital Charge Code |
1170411
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$14.24
|
| 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 |
$29.20
|
| 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 |
$14.24
|
| 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
|
|
