|
XR Spine Cervical 4 or 5 Views - Report
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 72050 26
|
| Hospital Charge Code |
629603
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AlohaCare Medicaid |
$35.91
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
|
|
XR Spine Cervical 6+ Views
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
1170461
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$669.60
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
|
|
XR Spine Cervical 6+ Views
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
1170461
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$41.90
|
| Rate for Payer: AlohaCare Medicare |
$69.51
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Devoted Health Medicare |
$76.46
|
| 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 |
$69.44
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.41
|
| 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 |
$41.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.51
|
| 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 6+ Views
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
1170461
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: AlohaCare Medicaid |
$372.00
|
| Rate for Payer: AlohaCare Medicare |
$372.00
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Devoted Health Medicare |
$409.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Humana Medicare |
$372.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.00
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.00
|
| Rate for Payer: University Health Alliance Commercial |
$132.40
|
|
|
XR Spine Cervical 6+ Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72052 26
|
| Hospital Charge Code |
629613
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$41.90
|
| Rate for Payer: AlohaCare Medicare |
$14.63
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.44
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.63
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
1170470
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$26.65
|
| Rate for Payer: AlohaCare Medicare |
$44.62
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Devoted Health Medicare |
$49.08
|
| 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 |
$41.42
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.54
|
| 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 |
$26.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.62
|
| 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 Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
1170470
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: AlohaCare Medicaid |
$289.00
|
| Rate for Payer: AlohaCare Medicare |
$289.00
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Devoted Health Medicare |
$317.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Humana Medicare |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.00
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.00
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
1170470
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.30 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
|
|
XR Spine Lumbosacral 2 or 3 Views - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 72100 26
|
| Hospital Charge Code |
630050
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$26.65
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.42
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
XR Spine Lumbosacral 4plus Views
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
1170476
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$108.35
|
|
|
XR Spine Lumbosacral 4plus Views
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
1170476
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
XR Spine Lumbosacral 4plus Views
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
1170476
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$59.06
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Devoted Health Medicare |
$64.97
|
| 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 |
$57.23
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.87
|
| 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 |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.06
|
| 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 Lumbosacral 4plus Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72110 26
|
| Hospital Charge Code |
630023
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$12.91
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$14.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.91
|
|
|
XR Spine Lumbosacral Bending 2-3 Views
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
1170472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| 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 |
$354.00
|
| 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 |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$97.90
|
|
|
XR Spine Lumbosacral Bending 2-3 Views
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
1170472
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.11
|
| Rate for Payer: AlohaCare Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$51.17
|
| 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 |
$51.52
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.82
|
| 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 |
$27.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.52
|
| 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 Lumbosacral Bending 2-3 Views
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
1170472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
XR Spine Lumbosacral Bending 2-3 Views - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 72120 26
|
| Hospital Charge Code |
630033
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$27.11
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.52
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
XR Spine Lumbosacral w/ Bending 6+ Views
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
1170474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$141.23
|
|
|
XR Spine Lumbosacral w/ Bending 6+ Views
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
1170474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
XR Spine Lumbosacral w/ Bending 6+ Views
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
1170474
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$40.98
|
| Rate for Payer: AlohaCare Medicare |
$68.37
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Devoted Health Medicare |
$75.21
|
| 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 |
$71.81
|
| Rate for Payer: Health Management Network Commercial |
$394.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.04
|
| 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 |
$40.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.37
|
| 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 Lumbosacral w/ Bending 6+ Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72114 26
|
| Hospital Charge Code |
630029
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$40.98
|
| Rate for Payer: AlohaCare Medicare |
$14.63
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.81
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.63
|
|
|
XR Spine Scoliosis 1 View
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
7520627
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$391.85 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
|
|
XR Spine Scoliosis 1 View
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
7520627
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: AlohaCare Medicaid |
$230.50
|
| Rate for Payer: AlohaCare Medicare |
$230.50
|
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Cash Price |
$299.65
|
| Rate for Payer: Devoted Health Medicare |
$253.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Humana Medicare |
$230.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$230.50
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.50
|
| Rate for Payer: University Health Alliance Commercial |
$80.07
|
|
|
XR Spine Scoliosis 1 View - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 72081 26
|
| Hospital Charge Code |
7520629
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$28.37
|
| Rate for Payer: AlohaCare Medicare |
$12.91
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$14.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.28
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.91
|
|
|
XR Spine Scoliosis 2-3 Views
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
7520630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$463.25 |
| Max. Negotiated Rate |
$528.65 |
| Rate for Payer: Cash Price |
$354.25
|
| Rate for Payer: Health Management Network Commercial |
$463.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$490.50
|
| Rate for Payer: MDX Hawaii PPO |
$528.65
|
|
