|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$27,674.17
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$21,100.98 |
| Max. Negotiated Rate |
$27,674.17 |
| Rate for Payer: AlohaCare Medicare |
$21,100.98
|
| Rate for Payer: Devoted Health Medicare |
$23,211.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24,926.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21,100.98
|
| Rate for Payer: Humana Medicare |
$21,100.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$27,674.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$21,100.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$21,100.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$21,100.98
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$22,708.79
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$13,557.87 |
| Max. Negotiated Rate |
$22,708.79 |
| Rate for Payer: AlohaCare Medicare |
$13,557.87
|
| Rate for Payer: Devoted Health Medicare |
$14,913.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,708.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13,557.87
|
| Rate for Payer: Humana Medicare |
$13,557.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,781.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$13,557.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$13,557.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$13,557.87
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$90,618.21
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$90,618.21 |
| Rate for Payer: AlohaCare Medicare |
$40,894.57
|
| Rate for Payer: Devoted Health Medicare |
$44,984.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$90,618.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40,894.57
|
| Rate for Payer: Humana Medicare |
$40,894.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$53,633.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$40,894.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$40,894.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$40,894.57
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$90,618.21
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$90,618.21 |
| Rate for Payer: AlohaCare Medicare |
$59,801.68
|
| Rate for Payer: Devoted Health Medicare |
$65,781.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$90,618.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59,801.68
|
| Rate for Payer: Humana Medicare |
$59,801.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$78,430.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$59,801.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$59,801.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$59,801.68
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$77,962.04
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$77,962.04 |
| Rate for Payer: AlohaCare Medicare |
$33,183.11
|
| Rate for Payer: Devoted Health Medicare |
$36,501.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77,962.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33,183.11
|
| Rate for Payer: Humana Medicare |
$33,183.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$43,520.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$33,183.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$33,183.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$33,183.11
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$40,186.98
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$40,186.98 |
| Max. Negotiated Rate |
$40,186.98 |
| Rate for Payer: AlohaCare Medicaid |
$40,186.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40,186.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40,186.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40,186.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40,186.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40,186.98
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$22,242.86
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$22,242.86 |
| Max. Negotiated Rate |
$22,242.86 |
| Rate for Payer: AlohaCare Medicaid |
$22,242.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22,242.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22,242.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22,242.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22,242.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22,242.86
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$12,251.77
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$12,251.77 |
| Max. Negotiated Rate |
$12,251.77 |
| Rate for Payer: AlohaCare Medicaid |
$12,251.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12,251.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12,251.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12,251.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12,251.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,251.77
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$15,927.30
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$15,927.30 |
| Max. Negotiated Rate |
$15,927.30 |
| Rate for Payer: AlohaCare Medicaid |
$15,927.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15,927.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15,927.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15,927.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,927.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15,927.30
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$228,703.11
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$88,532.58 |
| Max. Negotiated Rate |
$228,703.11 |
| Rate for Payer: AlohaCare Medicare |
$88,532.58
|
| Rate for Payer: Devoted Health Medicare |
$97,385.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228,703.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88,532.58
|
| Rate for Payer: Humana Medicare |
$88,532.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$116,111.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$88,532.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$88,532.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$88,532.58
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$106,649.37
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$106,649.37 |
| Rate for Payer: AlohaCare Medicare |
$75,369.30
|
| Rate for Payer: Devoted Health Medicare |
$82,906.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106,649.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75,369.30
|
| Rate for Payer: Humana Medicare |
$75,369.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$98,847.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$75,369.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$75,369.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$75,369.30
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$101,635.11
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$101,635.11 |
| Rate for Payer: AlohaCare Medicare |
$51,452.30
|
| Rate for Payer: Devoted Health Medicare |
$56,597.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$101,635.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51,452.30
|
| Rate for Payer: Humana Medicare |
$51,452.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$67,480.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$51,452.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$51,452.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$51,452.30
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CREATININE BLOOD
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 82565
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: AlohaCare Medicaid |
$7.07
|
| Rate for Payer: AlohaCare Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Devoted Health Medicare |
$5.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.08
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.12
|
|
|
Crossroads Scp Linked Il 15mm Nrw 7100-UA5N [3645519]
|
Facility
|
OP
|
$9,625.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3645519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,909.16 |
| Max. Negotiated Rate |
$9,337.03 |
| Rate for Payer: Cash Price |
$6,256.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,738.06
|
| Rate for Payer: Health Management Network Commercial |
$8,181.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,064.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,909.16
|
| Rate for Payer: MDX Hawaii PPO |
$9,337.03
|
| Rate for Payer: University Health Alliance Commercial |
$5,390.45
|
|
|
Crossroads Scp Linked Il 15mm Nrw 7100-UA5N [3645519]
|
Facility
|
IP
|
$9,625.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3645519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,390.45 |
| Max. Negotiated Rate |
$9,337.03 |
| Rate for Payer: Cash Price |
$6,256.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,738.06
|
| Rate for Payer: Health Management Network Commercial |
$8,181.93
|
| Rate for Payer: MDX Hawaii PPO |
$9,337.03
|
| Rate for Payer: University Health Alliance Commercial |
$5,390.45
|
|
|
CS15282VSP Cath Dialysis Arrow Cannon 15Fr X 23cm [3642465]
|
Facility
|
IP
|
$1,727.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
3642465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,468.38 |
| Max. Negotiated Rate |
$1,675.67 |
| Rate for Payer: Cash Price |
$1,122.88
|
| Rate for Payer: Health Management Network Commercial |
$1,468.38
|
| Rate for Payer: MDX Hawaii PPO |
$1,675.67
|
|
|
CS15282VSP Cath Dialysis Arrow Cannon 15Fr X 23cm [3642465]
|
Facility
|
OP
|
$1,727.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
3642465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.02 |
| Max. Negotiated Rate |
$1,675.67 |
| Rate for Payer: Cash Price |
$1,122.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,641.12
|
| Rate for Payer: Health Management Network Commercial |
$1,468.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,088.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$881.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,675.67
|
| Rate for Payer: University Health Alliance Commercial |
$1,259.17
|
|
|
CS15322VSP Cath Dialysis Arrow Cannon 15Fr X 27cm [3642466]
|
Facility
|
OP
|
$1,727.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
3642466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.02 |
| Max. Negotiated Rate |
$1,675.67 |
| Rate for Payer: Cash Price |
$1,122.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,641.12
|
| Rate for Payer: Health Management Network Commercial |
$1,468.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,088.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$881.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,675.67
|
| Rate for Payer: University Health Alliance Commercial |
$1,259.17
|
|
|
CS15322VSP Cath Dialysis Arrow Cannon 15Fr X 27cm [3642466]
|
Facility
|
IP
|
$1,727.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
3642466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,468.38 |
| Max. Negotiated Rate |
$1,675.67 |
| Rate for Payer: Cash Price |
$1,122.88
|
| Rate for Payer: Health Management Network Commercial |
$1,468.38
|
| Rate for Payer: MDX Hawaii PPO |
$1,675.67
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$207.63 |
| Max. Negotiated Rate |
$854.25 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$330.89
|
| Rate for Payer: Cash Price |
$653.25
|
| Rate for Payer: Cash Price |
$653.25
|
| Rate for Payer: Devoted Health Medicare |
$363.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$854.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.89
|
|
|
CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
HCPCS 74176
|
| Min. Negotiated Rate |
$122.73 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$198.28
|
| Rate for Payer: Cash Price |
$715.65
|
| Rate for Payer: Cash Price |
$715.65
|
| Rate for Payer: Devoted Health Medicare |
$218.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$935.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.28
|
|
|
CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 74178
|
| Min. Negotiated Rate |
$232.99 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$372.56
|
| Rate for Payer: Cash Price |
$730.60
|
| Rate for Payer: Cash Price |
$730.60
|
| Rate for Payer: Devoted Health Medicare |
$409.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.94
|
| Rate for Payer: Health Management Network Commercial |
$955.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$447.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$447.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.56
|
|
|
CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 74160
|
| Min. Negotiated Rate |
$159.93 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: AlohaCare Medicaid |
$159.93
|
| Rate for Payer: AlohaCare Medicare |
$254.31
|
| Rate for Payer: Cash Price |
$479.05
|
| Rate for Payer: Cash Price |
$479.05
|
| Rate for Payer: Devoted Health Medicare |
$279.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$254.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.34
|
| Rate for Payer: Health Management Network Commercial |
$626.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$305.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$305.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$254.31
|
|
|
CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$148.15
|
| Rate for Payer: Cash Price |
$289.25
|
| Rate for Payer: Cash Price |
$289.25
|
| Rate for Payer: Devoted Health Medicare |
$162.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.15
|
|
|
CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 74170
|
| Min. Negotiated Rate |
$179.97 |
| Max. Negotiated Rate |
$643.45 |
| Rate for Payer: AlohaCare Medicaid |
$179.97
|
| Rate for Payer: AlohaCare Medicare |
$286.37
|
| Rate for Payer: Cash Price |
$492.05
|
| Rate for Payer: Cash Price |
$492.05
|
| Rate for Payer: Devoted Health Medicare |
$315.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.50
|
| Rate for Payer: Health Management Network Commercial |
$643.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$343.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$343.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$343.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.37
|
|
