|
XR Venography Extremity Left
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
HCPCS 75820 LT
|
| Hospital Charge Code |
8196611
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,671.55 |
| Max. Negotiated Rate |
$3,048.71 |
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Health Management Network Commercial |
$2,671.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,828.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,048.71
|
|
|
XR Venography Extremity Left
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
HCPCS 75820 LT
|
| Hospital Charge Code |
8196611
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.51 |
| Max. Negotiated Rate |
$3,048.71 |
| Rate for Payer: AlohaCare Medicaid |
$1,571.50
|
| Rate for Payer: AlohaCare Medicare |
$1,571.50
|
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Devoted Health Medicare |
$1,728.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,571.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$34.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,985.85
|
| Rate for Payer: Health Management Network Commercial |
$2,671.55
|
| Rate for Payer: Humana Medicare |
$1,571.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,828.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,602.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,571.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,048.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,571.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,571.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,571.50
|
| Rate for Payer: University Health Alliance Commercial |
$215.77
|
|
|
XR Venography Extremity Right
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
HCPCS 75820 RT
|
| Hospital Charge Code |
8196614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,671.55 |
| Max. Negotiated Rate |
$3,048.71 |
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Health Management Network Commercial |
$2,671.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,828.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,048.71
|
|
|
XR Venography Extremity Right
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
HCPCS 75820 RT
|
| Hospital Charge Code |
8196614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.51 |
| Max. Negotiated Rate |
$3,048.71 |
| Rate for Payer: AlohaCare Medicaid |
$1,571.50
|
| Rate for Payer: AlohaCare Medicare |
$1,571.50
|
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Cash Price |
$2,042.95
|
| Rate for Payer: Devoted Health Medicare |
$1,728.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,571.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$34.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,985.85
|
| Rate for Payer: Health Management Network Commercial |
$2,671.55
|
| Rate for Payer: Humana Medicare |
$1,571.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,828.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,602.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,571.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,048.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,571.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,571.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,571.50
|
| Rate for Payer: University Health Alliance Commercial |
$215.77
|
|
|
XR Voiding Urethrocystography
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
8221477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$946.90 |
| Max. Negotiated Rate |
$1,080.58 |
| Rate for Payer: Cash Price |
$724.10
|
| Rate for Payer: Health Management Network Commercial |
$946.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,002.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,080.58
|
|
|
XR Voiding Urethrocystography
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
8221477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$1,080.58 |
| Rate for Payer: AlohaCare Medicaid |
$557.00
|
| Rate for Payer: AlohaCare Medicare |
$557.00
|
| Rate for Payer: Cash Price |
$724.10
|
| Rate for Payer: Cash Price |
$724.10
|
| Rate for Payer: Devoted Health Medicare |
$612.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$557.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$946.90
|
| Rate for Payer: Humana Medicare |
$557.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,002.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$557.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,080.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$557.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$557.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$557.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.02
|
|
|
XR Voiding Urethrocystography - Report
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 74455 26
|
| Hospital Charge Code |
2444308
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$70.38
|
| Rate for Payer: AlohaCare Medicare |
$16.01
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$17.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.01
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 50
|
| Hospital Charge Code |
1170604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: AlohaCare Medicaid |
$290.00
|
| Rate for Payer: AlohaCare Medicare |
$290.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Devoted Health Medicare |
$319.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$290.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Humana Medicare |
$290.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.00
|
| Rate for Payer: University Health Alliance Commercial |
$57.07
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 50
|
| Hospital Charge Code |
1170604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
|
|
XR Wrist 2 Views Bilateral - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73100 26,50
|
| Hospital Charge Code |
613631
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.70
|
|
|
XR Wrist 2 Views Left
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 LT
|
| Hospital Charge Code |
1170606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
|
|
XR Wrist 2 Views Left
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 LT
|
| Hospital Charge Code |
1170606
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: AlohaCare Medicaid |
$290.00
|
| Rate for Payer: AlohaCare Medicare |
$290.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Devoted Health Medicare |
$319.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$290.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Humana Medicare |
$290.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.00
|
| Rate for Payer: University Health Alliance Commercial |
$57.07
|
|
|
XR Wrist 2 Views Left
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73100 LT
|
| Hospital Charge Code |
1170606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$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 |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 |
$22.70
|
| 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 Wrist 2 Views Left - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73100 26,LT
|
| Hospital Charge Code |
613633
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.70
|
|
|
XR Wrist 2 Views Right
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 RT
|
| Hospital Charge Code |
1170608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: AlohaCare Medicaid |
$290.00
|
| Rate for Payer: AlohaCare Medicare |
$290.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Devoted Health Medicare |
$319.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$290.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Humana Medicare |
$290.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.00
|
| Rate for Payer: University Health Alliance Commercial |
$57.07
|
|
|
XR Wrist 2 Views Right
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 73100 RT
|
| Hospital Charge Code |
1170608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
|
|
XR Wrist 2 Views Right
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73100 RT
|
| Hospital Charge Code |
1170608
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$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 |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 |
$22.70
|
| 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 Wrist 2 Views Right - Report
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 73100 26,RT
|
| Hospital Charge Code |
613635
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.70
|
|
|
XR Wrist Complete 3+ Views Bilateral
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73110 50
|
| Hospital Charge Code |
1170610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: AlohaCare Medicaid |
$262.50
|
| Rate for Payer: AlohaCare Medicare |
$262.50
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Devoted Health Medicare |
$288.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$498.75
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Humana Medicare |
$262.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$66.60
|
|
|
XR Wrist Complete 3+ Views Bilateral
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 73110 50
|
| Hospital Charge Code |
1170610
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| 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 |
$27.72
|
| 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 Wrist Complete 3+ Views Bilateral
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73110 50
|
| Hospital Charge Code |
1170610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
|
|
XR Wrist Complete 3+ Views Bilateral - Report
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73110 26,50
|
| Hospital Charge Code |
611599
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
|
|
XR Wrist Complete 3+ Views Left
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 73110 LT
|
| Hospital Charge Code |
1170612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
|
|
XR Wrist Complete 3+ Views Left
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 73110 LT
|
| Hospital Charge Code |
1170612
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| 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 |
$27.72
|
| 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 Wrist Complete 3+ Views Left
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 73110 LT
|
| Hospital Charge Code |
1170612
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: AlohaCare Medicaid |
$262.50
|
| Rate for Payer: AlohaCare Medicare |
$262.50
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Devoted Health Medicare |
$288.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$498.75
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Humana Medicare |
$262.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.50
|
| Rate for Payer: MDX Hawaii PPO |
$509.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.50
|
| Rate for Payer: University Health Alliance Commercial |
$66.60
|
|
