|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 75716 26
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$103.42
|
| Rate for Payer: AlohaCare Medicare |
$89.84
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Devoted Health Medicare |
$98.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.84
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$77.86
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$85.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.86
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 75710 26
|
| Min. Negotiated Rate |
$79.41 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$79.41
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$87.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.41
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$157.27
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Devoted Health Medicare |
$173.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$328.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$188.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$188.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.27
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$182.39
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Devoted Health Medicare |
$200.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.39
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75756 TC
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$128.18
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$141.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.18
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 75756 26
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$54.21
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Devoted Health Medicare |
$59.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.21
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 75736 TC
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$105.40
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Devoted Health Medicare |
$115.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.40
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 75736 26
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$50.39
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Devoted Health Medicare |
$55.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.39
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$155.79
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Devoted Health Medicare |
$171.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$370.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.79
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$272.90
|
|
|
Service Code
|
HCPCS 75743
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$155.94
|
| Rate for Payer: Cash Price |
$163.74
|
| Rate for Payer: Cash Price |
$163.74
|
| Rate for Payer: Devoted Health Medicare |
$171.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$231.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.94
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Min. Negotiated Rate |
$80.90 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$80.90
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$88.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.90
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 75743 26
|
| Min. Negotiated Rate |
$75.04 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$75.04
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Devoted Health Medicare |
$82.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.04
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$137.54
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$151.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.54
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 75741 26
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$64.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.92
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 75741 TC
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$84.08
|
| Rate for Payer: AlohaCare Medicare |
$78.62
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$86.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.62
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 75705 26
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$121.25
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Devoted Health Medicare |
$133.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.25
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$190.46
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Devoted Health Medicare |
$209.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$228.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$228.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.46
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$545.49
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.34
|
| Rate for Payer: AlohaCare Medicare |
$311.71
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Cash Price |
$327.29
|
| Rate for Payer: Devoted Health Medicare |
$342.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$674.00
|
| Rate for Payer: Health Management Network Commercial |
$463.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$374.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$374.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.71
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$178.14
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Devoted Health Medicare |
$195.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$213.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.14
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 75726 TC
|
| Min. Negotiated Rate |
$86.97 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$86.97
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Devoted Health Medicare |
$95.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.97
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 75726 26
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$108.71
|
| Rate for Payer: AlohaCare Medicare |
$91.16
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Devoted Health Medicare |
$100.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.16
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$94.19
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$103.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.19
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75746 26
|
| Min. Negotiated Rate |
$51.72 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$51.72
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$56.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.72
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 75746
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.26
|
| Rate for Payer: AlohaCare Medicare |
$145.91
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Devoted Health Medicare |
$160.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.91
|
|
