|
XR Spine Scoliosis 2-3 Views
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
7520630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$528.65 |
| Rate for Payer: AlohaCare Medicaid |
$272.50
|
| Rate for Payer: AlohaCare Medicare |
$272.50
|
| Rate for Payer: Cash Price |
$354.25
|
| Rate for Payer: Cash Price |
$354.25
|
| Rate for Payer: Devoted Health Medicare |
$299.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$463.25
|
| Rate for Payer: Humana Medicare |
$272.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$490.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.50
|
| Rate for Payer: MDX Hawaii PPO |
$528.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.50
|
| Rate for Payer: University Health Alliance Commercial |
$130.35
|
|
|
XR Spine Scoliosis 2-3 Views
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
7520630
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$47.15
|
| Rate for Payer: AlohaCare Medicare |
$79.72
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$87.69
|
| 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 |
$70.46
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$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 |
$47.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.72
|
| 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 Spine Scoliosis 2-3 Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72082 26
|
| Hospital Charge Code |
7520632
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$47.15
|
| Rate for Payer: AlohaCare Medicare |
$15.34
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$16.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.46
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.34
|
|
|
XR Spine Scoliosis 4-5 Views
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 72083
|
| Hospital Charge Code |
7520624
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$53.34
|
| Rate for Payer: AlohaCare Medicare |
$88.65
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Devoted Health Medicare |
$97.52
|
| 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 |
$76.48
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.38
|
| 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 |
$53.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.65
|
| 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 Spine Scoliosis 4-5 Views
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 72083
|
| Hospital Charge Code |
7520624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: AlohaCare Medicaid |
$296.00
|
| Rate for Payer: AlohaCare Medicare |
$296.00
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Devoted Health Medicare |
$325.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Humana Medicare |
$296.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$296.00
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.00
|
| Rate for Payer: University Health Alliance Commercial |
$166.83
|
|
|
XR Spine Scoliosis 4-5 Views
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 72083
|
| Hospital Charge Code |
7520624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
|
|
XR Spine Scoliosis 4-5 Views - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 72083 26
|
| Hospital Charge Code |
7520626
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.34
|
| Rate for Payer: AlohaCare Medicare |
$17.44
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$19.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.48
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.44
|
|
|
XR Spine Scoliosis 6+ Views
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
HCPCS 72084
|
| Hospital Charge Code |
7520633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$657.05 |
| Max. Negotiated Rate |
$749.81 |
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Health Management Network Commercial |
$657.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.70
|
| Rate for Payer: MDX Hawaii PPO |
$749.81
|
|
|
XR Spine Scoliosis 6+ Views
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
HCPCS 72084
|
| Hospital Charge Code |
7520633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$749.81 |
| Rate for Payer: AlohaCare Medicaid |
$386.50
|
| Rate for Payer: AlohaCare Medicare |
$386.50
|
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Cash Price |
$502.45
|
| Rate for Payer: Devoted Health Medicare |
$425.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$386.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$57.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$657.05
|
| Rate for Payer: Humana Medicare |
$386.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$386.50
|
| Rate for Payer: MDX Hawaii PPO |
$749.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$386.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$386.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$386.50
|
| Rate for Payer: University Health Alliance Commercial |
$205.85
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
1170484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$437.75 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
1170484
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: AlohaCare Medicaid |
$21.89
|
| Rate for Payer: AlohaCare Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Devoted Health Medicare |
$39.94
|
| 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 |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
1170484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: AlohaCare Medicaid |
$257.50
|
| Rate for Payer: AlohaCare Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Devoted Health Medicare |
$283.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Humana Medicare |
$257.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$262.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.50
|
| Rate for Payer: University Health Alliance Commercial |
$70.43
|
|
|
XR Spine Thoracic 2 Views - Report
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 72070 26
|
| Hospital Charge Code |
630003
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicaid |
$21.89
|
| Rate for Payer: AlohaCare Medicare |
$9.91
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$10.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.91
|
|
|
XR Spine Thoracic 3 Views
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
1170486
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$26.39
|
| Rate for Payer: AlohaCare Medicare |
$42.67
|
| 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 |
$46.94
|
| 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 |
$44.41
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.20
|
| 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 |
$26.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.67
|
| 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 Thoracic 3 Views
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
1170486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$470.05 |
| Max. Negotiated Rate |
$536.41 |
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$497.70
|
| Rate for Payer: MDX Hawaii PPO |
$536.41
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
1170486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$536.41 |
| Rate for Payer: AlohaCare Medicaid |
$276.50
|
| Rate for Payer: AlohaCare Medicare |
$276.50
|
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Devoted Health Medicare |
$304.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$276.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Humana Medicare |
$276.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$497.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$282.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.50
|
| Rate for Payer: MDX Hawaii PPO |
$536.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$276.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$276.50
|
| Rate for Payer: University Health Alliance Commercial |
$78.96
|
|
|
XR Spine Thoracic 3 Views - Report
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 72072 26
|
| Hospital Charge Code |
629999
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicaid |
$26.39
|
| Rate for Payer: AlohaCare Medicare |
$10.58
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$11.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.41
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.58
|
|
|
XR Spine Thoracic 4+ Views
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
1170488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$465.80 |
| Max. Negotiated Rate |
$531.56 |
| Rate for Payer: Cash Price |
$356.20
|
| Rate for Payer: Health Management Network Commercial |
$465.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$493.20
|
| Rate for Payer: MDX Hawaii PPO |
$531.56
|
|
|
XR Spine Thoracic 4+ Views
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
1170488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$531.56 |
| Rate for Payer: AlohaCare Medicaid |
$274.00
|
| Rate for Payer: AlohaCare Medicare |
$274.00
|
| Rate for Payer: Cash Price |
$356.20
|
| Rate for Payer: Cash Price |
$356.20
|
| Rate for Payer: Devoted Health Medicare |
$301.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$274.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$465.80
|
| Rate for Payer: Humana Medicare |
$274.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$493.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$279.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$274.00
|
| Rate for Payer: MDX Hawaii PPO |
$531.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$274.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$274.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$274.00
|
| Rate for Payer: University Health Alliance Commercial |
$93.89
|
|
|
XR Spine Thoracic 4+ Views - Report
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 72074 26
|
| Hospital Charge Code |
629995
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicaid |
$29.77
|
| Rate for Payer: AlohaCare Medicare |
$11.63
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$12.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.34
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.63
|
|
|
XR Spine Thoracolumbar 2+ Views
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
1170490
|
|
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 Thoracolumbar 2+ Views
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
1170490
|
|
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 |
$111.14
|
| 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 |
$88.91
|
| 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 |
$72.83
|
|
|
XR Spine Thoracolumbar 2+ Views
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
1170490
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.01
|
| Rate for Payer: AlohaCare Medicare |
$38.59
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Devoted Health Medicare |
$42.45
|
| 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 |
$41.42
|
| Rate for Payer: Health Management Network Commercial |
$149.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.31
|
| 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 |
$23.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.59
|
| 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 Spine Thoracolumbar 2+ Views - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 72080 26
|
| Hospital Charge Code |
629987
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$23.01
|
| Rate for Payer: AlohaCare Medicare |
$10.29
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$11.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.29
|
| 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 |
$12.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.29
|
|
|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
1170494
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$45.76
|
| 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 |
$50.34
|
| 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 |
$42.95
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.91
|
| 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 |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.76
|
| 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
|
|
