|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 74174 26
|
| 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 |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| 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 |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.92
|
| 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
|
|
|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$260.30 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$417.27
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Devoted Health Medicare |
$459.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$417.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.18
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$500.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$417.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$417.27
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 74177 26
|
| Min. Negotiated Rate |
$85.17 |
| Max. Negotiated Rate |
$393.28 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$85.17
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| 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 |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.20
|
| 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
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Min. Negotiated Rate |
$207.63 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$245.72
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Devoted Health Medicare |
$270.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$702.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.72
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$207.63 |
| Max. Negotiated Rate |
$829.60 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$330.89
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| 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 |
$829.60
|
| 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
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 74176 26
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$81.31
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| 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 |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.57
|
| 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
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Min. Negotiated Rate |
$116.98 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$116.98
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Devoted Health Medicare |
$128.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.98
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 74176
|
| Min. Negotiated Rate |
$122.73 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$198.28
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| 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 |
$453.90
|
| 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
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 74150 26
|
| 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 |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| 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 |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.80
|
| 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
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$148.15
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| 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 |
$345.95
|
| 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
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$313.29 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$92.48
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Devoted Health Medicare |
$101.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.48
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Min. Negotiated Rate |
$232.99 |
| Max. Negotiated Rate |
$499.94 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$278.19
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Devoted Health Medicare |
$306.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.94
|
| Rate for Payer: Health Management Network Commercial |
$414.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.19
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 74178
|
| Min. Negotiated Rate |
$232.99 |
| Max. Negotiated Rate |
$554.20 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$372.56
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| 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 |
$554.20
|
| 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
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 74178 26
|
| 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 |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| 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 |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.24
|
| 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
|
|
|
CHG CTA HEAD&NECK C+ W/NONCONTRAST IMG&POST-PXESSING
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 70471 26
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: AlohaCare Medicare |
$120.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Devoted Health Medicare |
$132.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.20
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.20
|
|
|
CHG CTA HEAD&NECK C+ W/NONCONTRAST IMG&POST-PXESSING
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 70471 TC
|
| Min. Negotiated Rate |
$293.38 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: AlohaCare Medicare |
$293.38
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$322.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$293.38
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$352.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$352.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$293.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$293.38
|
|
|
CHG CTA HEAD&NECK C+ W/NONCONTRAST IMG&POST-PXESSING
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 70471
|
| Min. Negotiated Rate |
$413.58 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: AlohaCare Medicare |
$413.58
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Devoted Health Medicare |
$454.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$413.58
|
| Rate for Payer: Health Management Network Commercial |
$614.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$496.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$496.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$413.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$413.58
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 75574 TC
|
| Min. Negotiated Rate |
$218.29 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: AlohaCare Medicaid |
$218.29
|
| Rate for Payer: AlohaCare Medicare |
$243.83
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Devoted Health Medicare |
$268.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.83
|
| Rate for Payer: Health Management Network Commercial |
$685.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$292.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$292.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.83
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$218.29 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: AlohaCare Medicaid |
$218.29
|
| Rate for Payer: AlohaCare Medicare |
$356.58
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Devoted Health Medicare |
$392.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.58
|
| Rate for Payer: Health Management Network Commercial |
$852.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$427.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$427.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$427.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.58
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 75574 26
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$218.29 |
| Rate for Payer: AlohaCare Medicaid |
$218.29
|
| Rate for Payer: AlohaCare Medicare |
$112.76
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$124.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.76
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$135.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.76
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$191.79 |
| Max. Negotiated Rate |
$453.86 |
| Rate for Payer: AlohaCare Medicaid |
$191.79
|
| Rate for Payer: AlohaCare Medicare |
$308.30
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Devoted Health Medicare |
$339.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.86
|
| Rate for Payer: Health Management Network Commercial |
$428.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$369.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.30
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Min. Negotiated Rate |
$191.79 |
| Max. Negotiated Rate |
$453.86 |
| Rate for Payer: AlohaCare Medicaid |
$191.79
|
| Rate for Payer: AlohaCare Medicare |
$223.50
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$245.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.86
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.50
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 71275 26
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$453.86 |
| Rate for Payer: AlohaCare Medicaid |
$191.79
|
| Rate for Payer: AlohaCare Medicare |
$84.79
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Devoted Health Medicare |
$93.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.86
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.79
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 73206 26
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$570.76 |
| Rate for Payer: AlohaCare Medicaid |
$202.84
|
| Rate for Payer: AlohaCare Medicare |
$83.70
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Devoted Health Medicare |
$92.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.76
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.70
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 73206 TC
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$570.76 |
| Rate for Payer: AlohaCare Medicaid |
$202.84
|
| Rate for Payer: AlohaCare Medicare |
$241.73
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$265.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.76
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.73
|
|
