|
CT Abdomen and Pelvis w/ Contrast
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
HCPCS 74177
|
| Hospital Charge Code |
2424647
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,990.30 |
| Max. Negotiated Rate |
$3,412.46 |
| Rate for Payer: Cash Price |
$2,286.70
|
| Rate for Payer: Health Management Network Commercial |
$2,990.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,166.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,412.46
|
|
|
CT Abdomen and Pelvis w/ Contrast - Report
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 74177 26
|
| Hospital Charge Code |
2424649
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$85.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$85.17
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Devoted Health Medicare |
$93.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.17
|
|
|
CT Abdomen and Pelvis w/o Contrast
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
HCPCS 74176
|
| Hospital Charge Code |
2424650
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,320.50 |
| Max. Negotiated Rate |
$2,648.10 |
| Rate for Payer: Cash Price |
$1,774.50
|
| Rate for Payer: Health Management Network Commercial |
$2,320.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,457.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,648.10
|
|
|
CT Abdomen and Pelvis w/o Contrast
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
HCPCS 74176
|
| Hospital Charge Code |
2424650
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$2,648.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,365.00
|
| Rate for Payer: AlohaCare Medicare |
$1,365.00
|
| Rate for Payer: Cash Price |
$1,774.50
|
| Rate for Payer: Cash Price |
$1,774.50
|
| Rate for Payer: Devoted Health Medicare |
$1,501.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,365.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$413.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$2,320.50
|
| Rate for Payer: Humana Medicare |
$1,365.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,457.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,392.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,365.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,648.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,365.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,365.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,365.00
|
| Rate for Payer: University Health Alliance Commercial |
$454.47
|
|
|
CT Abdomen and Pelvis w/o Contrast - Report
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 74176 26
|
| Hospital Charge Code |
2424652
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$81.31
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Cash Price |
$199.55
|
| Rate for Payer: Devoted Health Medicare |
$89.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.31
|
|
|
CT Abdomen and Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
2424644
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,123.75 |
| Max. Negotiated Rate |
$3,564.75 |
| Rate for Payer: Cash Price |
$2,388.75
|
| Rate for Payer: Health Management Network Commercial |
$3,123.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,307.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,564.75
|
|
|
CT Abdomen and Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
2424644
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$238.75 |
| Max. Negotiated Rate |
$3,564.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,837.50
|
| Rate for Payer: AlohaCare Medicare |
$1,837.50
|
| Rate for Payer: Cash Price |
$2,388.75
|
| Rate for Payer: Cash Price |
$2,388.75
|
| Rate for Payer: Devoted Health Medicare |
$2,021.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$238.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,837.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$606.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$3,123.75
|
| Rate for Payer: Humana Medicare |
$1,837.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,307.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,874.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,837.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,564.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,837.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,837.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$238.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,837.50
|
| Rate for Payer: University Health Alliance Commercial |
$924.87
|
|
|
CT Abdomen and Pelvis w/ + w/o Contrast - Report
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 74178 26
|
| Hospital Charge Code |
2424646
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$499.94 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$94.37
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Devoted Health Medicare |
$103.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.94
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.37
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
1167847
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,754.40 |
| Max. Negotiated Rate |
$2,002.08 |
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Health Management Network Commercial |
$1,754.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,857.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,002.08
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
1167847
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$2,002.08 |
| Rate for Payer: AlohaCare Medicaid |
$1,032.00
|
| Rate for Payer: AlohaCare Medicare |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Devoted Health Medicare |
$1,135.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$225.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,032.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$245.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$1,754.40
|
| Rate for Payer: Humana Medicare |
$1,032.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,857.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,032.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,002.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,032.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,032.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,032.00
|
| Rate for Payer: University Health Alliance Commercial |
$691.79
|
|
|
CT Abdomen w/ Contrast - Report
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 74160 26
|
| Hospital Charge Code |
625599
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: AlohaCare Medicaid |
$159.93
|
| Rate for Payer: AlohaCare Medicare |
$59.48
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$65.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.34
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.48
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
1167849
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$106.81 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$795.00
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Devoted Health Medicare |
$874.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$795.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$202.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$795.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$795.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$795.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$795.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$795.00
|
| Rate for Payer: University Health Alliance Commercial |
$505.20
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
1167849
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
CT Abdomen w/o Contrast - Report
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 74150 26
|
| Hospital Charge Code |
625601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$313.29 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$55.67
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$61.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.67
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$2,272.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
1167845
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$2,203.84 |
| Rate for Payer: AlohaCare Medicaid |
$1,136.00
|
| Rate for Payer: AlohaCare Medicare |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Devoted Health Medicare |
$1,249.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$279.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,136.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$303.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$1,931.20
|
| Rate for Payer: Humana Medicare |
$1,136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,044.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,158.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,136.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,203.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,136.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,136.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$279.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,136.00
|
| Rate for Payer: University Health Alliance Commercial |
$803.12
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$2,272.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
1167845
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,931.20 |
| Max. Negotiated Rate |
$2,203.84 |
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Health Management Network Commercial |
$1,931.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,044.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,203.84
|
|
|
CT Abdomen w/ + w/o Contrast - Report
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 74170 26
|
| Hospital Charge Code |
615591
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$449.50 |
| Rate for Payer: AlohaCare Medicaid |
$179.97
|
| Rate for Payer: AlohaCare Medicare |
$65.34
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Devoted Health Medicare |
$71.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.50
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.34
|
|
|
CT Angio Abdomen
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
1167853
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$2,321.21 |
| Rate for Payer: AlohaCare Medicaid |
$1,196.50
|
| Rate for Payer: AlohaCare Medicare |
$1,196.50
|
| Rate for Payer: Cash Price |
$1,555.45
|
| Rate for Payer: Cash Price |
$1,555.45
|
| Rate for Payer: Devoted Health Medicare |
$1,316.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$311.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,196.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$424.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$2,034.05
|
| Rate for Payer: Humana Medicare |
$1,196.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,153.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,220.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,196.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,321.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,196.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,196.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$311.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,196.50
|
| Rate for Payer: University Health Alliance Commercial |
$858.03
|
|
|
CT Angio Abdomen
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
1167853
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,034.05 |
| Max. Negotiated Rate |
$2,321.21 |
| Rate for Payer: Cash Price |
$1,555.45
|
| Rate for Payer: Health Management Network Commercial |
$2,034.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,153.70
|
| Rate for Payer: MDX Hawaii PPO |
$2,321.21
|
|
|
CT Angio Abdomen and Pelvis
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
2424686
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,328.15 |
| Max. Negotiated Rate |
$2,656.83 |
| Rate for Payer: Cash Price |
$1,780.35
|
| Rate for Payer: Health Management Network Commercial |
$2,328.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,465.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,656.83
|
|
|
CT Angio Abdomen and Pelvis
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
2424686
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$316.18 |
| Max. Negotiated Rate |
$2,656.83 |
| Rate for Payer: AlohaCare Medicaid |
$1,369.50
|
| Rate for Payer: AlohaCare Medicare |
$1,369.50
|
| Rate for Payer: Cash Price |
$1,780.35
|
| Rate for Payer: Cash Price |
$1,780.35
|
| Rate for Payer: Devoted Health Medicare |
$1,506.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$316.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,369.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$430.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$2,328.15
|
| Rate for Payer: Humana Medicare |
$1,369.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,465.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,396.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,369.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,656.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,369.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,369.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,369.50
|
| Rate for Payer: University Health Alliance Commercial |
$851.02
|
|
|
CT Angio Abdomen and Pelvis - Report
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 74174 26
|
| Hospital Charge Code |
2424688
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$571.18 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$102.43
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Devoted Health Medicare |
$112.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.18
|
| Rate for Payer: Health Management Network Commercial |
$413.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.43
|
|
|
CT Angio Abdomen - Report
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 74175 26
|
| Hospital Charge Code |
625597
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$622.29 |
| Rate for Payer: AlohaCare Medicaid |
$209.00
|
| Rate for Payer: AlohaCare Medicare |
$84.41
|
| Rate for Payer: Cash Price |
$232.05
|
| Rate for Payer: Cash Price |
$232.05
|
| Rate for Payer: Devoted Health Medicare |
$92.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$622.29
|
| Rate for Payer: Health Management Network Commercial |
$303.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.41
|
|
|
CT Angio Brain/Head
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
1167871
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,522.35 |
| Max. Negotiated Rate |
$1,737.27 |
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: Health Management Network Commercial |
$1,522.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,611.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,737.27
|
|
|
CT Angio Brain/Head
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
1167871
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$1,737.27 |
| Rate for Payer: AlohaCare Medicaid |
$895.50
|
| Rate for Payer: AlohaCare Medicare |
$895.50
|
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: Devoted Health Medicare |
$985.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$279.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$895.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$380.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$1,522.35
|
| Rate for Payer: Humana Medicare |
$895.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,611.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$913.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$895.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,737.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$895.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$895.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$279.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$895.50
|
| Rate for Payer: University Health Alliance Commercial |
$842.03
|
|
