|
XR Shoulder 1 View Right - Report
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 73020 26,RT
|
| Hospital Charge Code |
630143
|
|
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 Complete 2+ Views Bilat
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73030 50
|
| Hospital Charge Code |
8211707
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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 Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| 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
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
|
|
XR Shoulder Complete 2+ Views Bilat
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 50
|
| Hospital Charge Code |
8211707
|
|
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 |
$61.92
|
|
|
XR Shoulder Complete 2+ Views Bilat
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 50
|
| Hospital Charge Code |
8211707
|
|
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 Shoulder Complete 2+ Views Bilat - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73030 26,50
|
| Hospital Charge Code |
8211709
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
|
|
XR Shoulder Complete 2+ Views Left
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 73030 LT
|
| Hospital Charge Code |
1170415
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| 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 |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| 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 |
$23.33
|
| 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 Shoulder Complete 2+ Views Left
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 LT
|
| Hospital Charge Code |
1170415
|
|
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 Shoulder Complete 2+ Views Left
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 LT
|
| Hospital Charge Code |
1170415
|
|
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 |
$61.92
|
|
|
XR Shoulder Complete 2+ Views Left - Report
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73030 26,LT
|
| Hospital Charge Code |
630127
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
|
|
XR Shoulder Complete 2+ Views Right
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 RT
|
| Hospital Charge Code |
1170417
|
|
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 |
$61.92
|
|
|
XR Shoulder Complete 2+ Views Right
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 73030 RT
|
| Hospital Charge Code |
1170417
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| 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 |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| 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 |
$23.33
|
| 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 Shoulder Complete 2+ Views Right
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73030 RT
|
| Hospital Charge Code |
1170417
|
|
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 Shoulder Complete 2+ Views Right - Report
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73030 26,RT
|
| Hospital Charge Code |
630123
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
|
|
XR Sialogram
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
1170430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.03 |
| Max. Negotiated Rate |
$717.80 |
| Rate for Payer: AlohaCare Medicaid |
$370.00
|
| Rate for Payer: AlohaCare Medicare |
$370.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Devoted Health Medicare |
$407.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$370.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$629.00
|
| Rate for Payer: Humana Medicare |
$370.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$666.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$377.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$370.00
|
| Rate for Payer: MDX Hawaii PPO |
$717.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$370.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$370.00
|
| Rate for Payer: University Health Alliance Commercial |
$200.58
|
|
|
XR Sialogram
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
1170430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$629.00 |
| Max. Negotiated Rate |
$717.80 |
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Health Management Network Commercial |
$629.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$666.00
|
| Rate for Payer: MDX Hawaii PPO |
$717.80
|
|
|
XR Sialogram - Report
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 70390 26
|
| Hospital Charge Code |
630111
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$144.30
|
| Rate for Payer: Cash Price |
$144.30
|
| Rate for Payer: Devoted Health Medicare |
$19.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.09
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.68
|
|
|
XR Sinuses Paranasal < 3 Views
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
1170432
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.52
|
| Rate for Payer: AlohaCare Medicare |
$35.69
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$39.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.70
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.69
|
| 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 Sinuses Paranasal < 3 Views
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
1170432
|
|
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 Sinuses Paranasal < 3 Views
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
1170432
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| 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 |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| 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 |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.00
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
XR Sinuses Paranasal < 3 Views - Report
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 70210 26
|
| Hospital Charge Code |
630107
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: AlohaCare Medicaid |
$21.52
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| 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 |
$36.70
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| 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 |
$21.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
XR Sinuses Paranasal Complete
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
1170434
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: AlohaCare Medicaid |
$268.00
|
| Rate for Payer: AlohaCare Medicare |
$268.00
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Devoted Health Medicare |
$294.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Humana Medicare |
$268.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.00
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$268.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.00
|
| Rate for Payer: University Health Alliance Commercial |
$82.68
|
|
|
XR Sinuses Paranasal Complete
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
1170434
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$25.04
|
| Rate for Payer: AlohaCare Medicare |
$41.58
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$45.74
|
| 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 |
$48.65
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.90
|
| 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 |
$25.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.58
|
| 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 Sinuses Paranasal Complete
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
1170434
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
|
|
XR Sinuses Paranasal Complete - Report
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70220 26
|
| Hospital Charge Code |
630101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: AlohaCare Medicaid |
$25.04
|
| Rate for Payer: AlohaCare Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$11.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.65
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.63
|
|
|
XR Skull < 4 Views
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
1170436
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| 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 |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| 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 |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.00
|
| Rate for Payer: University Health Alliance Commercial |
$72.65
|
|
