|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
1170494
|
|
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 Sternoclavicular Joint(s)
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
1170494
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.21 |
| 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 |
$23.21
|
| 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 |
$25.49
|
| 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 |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.50
|
| Rate for Payer: University Health Alliance Commercial |
$76.85
|
|
|
XR Sternoclavicular Joint(s) - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 71130 26
|
| Hospital Charge Code |
629977
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| 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 |
$42.95
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| 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 |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.63
|
|
|
XR Sternum 2+ Views
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
1170496
|
|
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 Sternum 2+ Views
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
1170496
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| 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 |
$39.48
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.57
|
| 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 |
$22.35
|
| 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 Sternum 2+ Views
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
1170496
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| 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 |
$21.34
|
| 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 |
$23.43
|
| 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 |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.50
|
| Rate for Payer: University Health Alliance Commercial |
$69.73
|
|
|
XR Sternum 2+ Views - Report
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 71120 26
|
| Hospital Charge Code |
629975
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$9.53
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$10.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.48
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.53
|
|
|
XR Swallowing Function w/ Speech
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Hospital Charge Code |
1170500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$687.73 |
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Health Management Network Commercial |
$602.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$638.10
|
| Rate for Payer: MDX Hawaii PPO |
$687.73
|
|
|
XR Swallowing Function w/ Speech
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Hospital Charge Code |
1170500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$687.73 |
| Rate for Payer: AlohaCare Medicaid |
$354.50
|
| Rate for Payer: AlohaCare Medicare |
$354.50
|
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Devoted Health Medicare |
$389.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$673.55
|
| Rate for Payer: Health Management Network Commercial |
$602.65
|
| Rate for Payer: Humana Medicare |
$354.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$638.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.50
|
| Rate for Payer: MDX Hawaii PPO |
$687.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.50
|
| Rate for Payer: University Health Alliance Commercial |
$126.97
|
|
|
XR Swallowing Function w/ Speech - Report
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74230 26
|
| Hospital Charge Code |
629965
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$83.78
|
| Rate for Payer: AlohaCare Medicare |
$25.16
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$27.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.47
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.16
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 50
|
| Hospital Charge Code |
1170514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.35 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
|
|
XR Tibia/Fibula Bilateral
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 73590 50
|
| Hospital Charge Code |
1170514
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 50
|
| Hospital Charge Code |
1170514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$215.50
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Devoted Health Medicare |
$237.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.45
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Humana Medicare |
$215.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.50
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
XR Tibia/Fibula Bilateral - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73590 26,50
|
| Hospital Charge Code |
629947
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR Tibia/Fibula Left
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
1170516
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
XR Tibia/Fibula Left
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
1170516
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$215.50
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Devoted Health Medicare |
$237.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.45
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Humana Medicare |
$215.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.50
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
XR Tibia/Fibula Left
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
1170516
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.35 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
|
|
XR Tibia/Fibula Left - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73590 26,LT
|
| Hospital Charge Code |
629943
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
1170518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$215.50
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Devoted Health Medicare |
$237.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.45
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Humana Medicare |
$215.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.50
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
XR Tibia/Fibula Right
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
1170518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.35 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
|
|
XR Tibia/Fibula Right - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73590 26,RT
|
| Hospital Charge Code |
629937
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
|
|
XR TMJ Open and Closed Bilateral
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
1170502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.83 |
| 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 |
$27.83
|
| 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 |
$30.26
|
| 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 |
$27.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.50
|
| Rate for Payer: University Health Alliance Commercial |
$94.79
|
|
|
XR TMJ Open and Closed Bilateral
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
1170502
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$35.54
|
| Rate for Payer: AlohaCare Medicare |
$59.34
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Devoted Health Medicare |
$65.27
|
| 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 |
$50.38
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.21
|
| 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 |
$35.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.34
|
| 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 TMJ Open and Closed Bilateral
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
1170502
|
|
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 TMJ Open and Closed Bilateral - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70330 26
|
| Hospital Charge Code |
629933
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$35.54
|
| Rate for Payer: AlohaCare Medicare |
$11.67
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$12.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.38
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.67
|
|
