|
HC CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
3527212601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
|
|
HC CT SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
3527212901
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CT SCAN DORSAL SP CONTRAST - CT THORACIC SPINE W CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
3527212901
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$253.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$684.78
|
|
|
HC CT SCAN, FACE/JAW CONTRAST - CT SINUS FACIAL BONES W CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
3517048702
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CT SCAN, FACE/JAW CONTRAST - CT SINUS FACIAL BONES W CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
3517048702
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$202.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$678.04
|
|
|
HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$465.11
|
|
|
HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$253.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$718.67
|
|
|
HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$202.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$591.56
|
|
|
HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
3507638001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$115.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$297.96
|
|
|
HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
3507638001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$163.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$177.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$497.32
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$232.90 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$253.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,118.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$905.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$683.96
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$177.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$177.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$502.27
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$500.94
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW W AND WO IV CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$267.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$785.42
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW W AND WO IV CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND W AND WO IV CONTRAST
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$267.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$785.42
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND W AND WO IV CONTRAST
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
