|
XR Skull < 4 Views
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
1170436
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.01
|
| Rate for Payer: AlohaCare Medicare |
$39.44
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$43.38
|
| 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 |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.33
|
| 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 |
$24.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.44
|
| 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 Skull < 4 Views
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
1170436
|
|
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 Skull < 4 Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 70250 26
|
| Hospital Charge Code |
630097
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$24.01
|
| Rate for Payer: AlohaCare Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| 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 |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| 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 |
$24.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
|
XR Skull Complete
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
1170438
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$531.25 |
| Max. Negotiated Rate |
$606.25 |
| Rate for Payer: Cash Price |
$406.25
|
| Rate for Payer: Health Management Network Commercial |
$531.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$562.50
|
| Rate for Payer: MDX Hawaii PPO |
$606.25
|
|
|
XR Skull Complete
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
1170438
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$606.25 |
| Rate for Payer: AlohaCare Medicaid |
$312.50
|
| Rate for Payer: AlohaCare Medicare |
$312.50
|
| Rate for Payer: Cash Price |
$406.25
|
| Rate for Payer: Cash Price |
$406.25
|
| Rate for Payer: Devoted Health Medicare |
$343.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$312.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$531.25
|
| Rate for Payer: Humana Medicare |
$312.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$562.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$318.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.50
|
| Rate for Payer: MDX Hawaii PPO |
$606.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$312.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$312.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$312.50
|
| Rate for Payer: University Health Alliance Commercial |
$100.57
|
|
|
XR Skull Complete - Report
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 70260 26
|
| Hospital Charge Code |
630093
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: AlohaCare Medicaid |
$29.68
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.17
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
|
|
XR Small Bowel w/ Multiple Series
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
1170442
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$786.25 |
| Max. Negotiated Rate |
$897.25 |
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$832.50
|
| Rate for Payer: MDX Hawaii PPO |
$897.25
|
|
|
XR Small Bowel w/ Multiple Series
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
1170442
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$897.25 |
| Rate for Payer: AlohaCare Medicaid |
$462.50
|
| Rate for Payer: AlohaCare Medicare |
$462.50
|
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Devoted Health Medicare |
$508.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Humana Medicare |
$462.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$832.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$471.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$462.50
|
| Rate for Payer: MDX Hawaii PPO |
$897.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.50
|
| Rate for Payer: University Health Alliance Commercial |
$191.35
|
|
|
XR Small Bowel w/ Multiple Series - Report
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 74250 26
|
| Hospital Charge Code |
630085
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$37.99
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$41.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.99
|
|
|
XR Spinal Puncture Diagnostic
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8127621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.60 |
| Max. Negotiated Rate |
$1,101.92 |
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
|
|
XR Spinal Puncture Diagnostic
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8127621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$568.00
|
| Rate for Payer: AlohaCare Medicare |
$568.00
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Devoted Health Medicare |
$624.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$901.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$568.00
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Humana Medicare |
$568.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$568.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$568.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
XR Spinal Puncture Diagnostic - Report
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8127623
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$61.33
|
| Rate for Payer: AlohaCare Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$61.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.68
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.99
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
XR Spinal Puncture Therapeutic
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
8127624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$568.00
|
| Rate for Payer: AlohaCare Medicare |
$568.00
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Devoted Health Medicare |
$624.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$901.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$568.00
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Humana Medicare |
$568.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$568.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$568.00
|
| Rate for Payer: University Health Alliance Commercial |
$636.16
|
|
|
XR Spinal Puncture Therapeutic
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
8127624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.60 |
| Max. Negotiated Rate |
$1,101.92 |
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
|
|
XR Spinal Puncture Therapeutic - Report
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
8127626
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$88.34
|
| Rate for Payer: AlohaCare Medicare |
$80.65
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$88.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$88.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$88.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.65
|
| Rate for Payer: University Health Alliance Commercial |
$115.85
|
|
|
XR Spine 1 View Specify Level
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
8102151
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: AlohaCare Medicaid |
$261.50
|
| Rate for Payer: AlohaCare Medicare |
$261.50
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Devoted Health Medicare |
$287.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Humana Medicare |
$261.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$470.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$261.50
|
| Rate for Payer: MDX Hawaii PPO |
$507.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$261.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.50
|
| Rate for Payer: University Health Alliance Commercial |
$48.36
|
|
|
XR Spine 1 View Specify Level
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
8102151
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.55 |
| Max. Negotiated Rate |
$507.31 |
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$470.70
|
| Rate for Payer: MDX Hawaii PPO |
$507.31
|
|
|
XR Spine 1 View Specify Level - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 72020 26
|
| Hospital Charge Code |
8102153
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$16.04
|
| Rate for Payer: AlohaCare Medicare |
$7.82
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$8.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.85
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.82
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
1170452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
|
|
XR Spine Cervical 2 or 3 Views
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
1170452
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$26.42
|
| Rate for Payer: AlohaCare Medicare |
$43.86
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$48.25
|
| 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 |
$38.42
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.63
|
| 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 |
$26.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.86
|
| 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 Spine Cervical 2 or 3 Views
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
1170452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: AlohaCare Medicaid |
$243.50
|
| Rate for Payer: AlohaCare Medicare |
$243.50
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Devoted Health Medicare |
$267.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Humana Medicare |
$243.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.50
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
XR Spine Cervical 2 or 3 Views - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 72040 26
|
| Hospital Charge Code |
629601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$26.42
|
| Rate for Payer: AlohaCare Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| 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 |
$38.42
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 |
$26.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.63
|
|
|
XR Spine Cervical 4 or 5 Views
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
1170454
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$35.91
|
| Rate for Payer: AlohaCare Medicare |
$60.91
|
| Rate for Payer: Cash Price |
$155.35
|
| Rate for Payer: Cash Price |
$155.35
|
| Rate for Payer: Cash Price |
$155.35
|
| Rate for Payer: Devoted Health Medicare |
$67.00
|
| 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 |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$203.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.09
|
| 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 |
$35.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.91
|
| 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 Spine Cervical 4 or 5 Views
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
1170454
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$573.27 |
| Rate for Payer: AlohaCare Medicaid |
$295.50
|
| Rate for Payer: AlohaCare Medicare |
$295.50
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Devoted Health Medicare |
$325.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Humana Medicare |
$295.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.50
|
| Rate for Payer: MDX Hawaii PPO |
$573.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.50
|
| Rate for Payer: University Health Alliance Commercial |
$105.14
|
|
|
XR Spine Cervical 4 or 5 Views
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
1170454
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$502.35 |
| Max. Negotiated Rate |
$573.27 |
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.90
|
| Rate for Payer: MDX Hawaii PPO |
$573.27
|
|
