|
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
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: AlohaCare Medicaid |
$88.11
|
| Rate for Payer: AlohaCare Medicare |
$142.70
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Devoted Health Medicare |
$156.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$340.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.70
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 72125 26
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$88.11
|
| Rate for Payer: AlohaCare Medicare |
$47.19
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$51.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.19
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 72125 TC
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$88.11
|
| Rate for Payer: AlohaCare Medicare |
$95.52
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Devoted Health Medicare |
$105.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.52
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$312.27
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$265.43 |
| Max. Negotiated Rate |
$265.43 |
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Health Management Network Commercial |
$265.43
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$349.73 |
| Rate for Payer: AlohaCare Medicaid |
$90.06
|
| Rate for Payer: AlohaCare Medicare |
$131.21
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Devoted Health Medicare |
$144.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.73
|
| Rate for Payer: Health Management Network Commercial |
$283.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.21
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 77012 26
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$349.73 |
| Rate for Payer: AlohaCare Medicaid |
$90.06
|
| Rate for Payer: AlohaCare Medicare |
$67.98
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$74.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.73
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.98
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 77012 TC
|
| Min. Negotiated Rate |
$63.23 |
| Max. Negotiated Rate |
$349.73 |
| Rate for Payer: AlohaCare Medicaid |
$90.06
|
| Rate for Payer: AlohaCare Medicare |
$63.23
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Devoted Health Medicare |
$69.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.73
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.23
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: AlohaCare Medicaid |
$71.70
|
| Rate for Payer: AlohaCare Medicare |
$116.23
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Devoted Health Medicare |
$127.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.45
|
| Rate for Payer: Health Management Network Commercial |
$277.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.23
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 70450 26
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: AlohaCare Medicaid |
$71.70
|
| Rate for Payer: AlohaCare Medicare |
$40.08
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.45
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.08
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: AlohaCare Medicaid |
$71.70
|
| Rate for Payer: AlohaCare Medicare |
$76.15
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Devoted Health Medicare |
$83.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.45
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.15
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 75573
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$501.50 |
| Rate for Payer: AlohaCare Medicaid |
$204.87
|
| Rate for Payer: AlohaCare Medicare |
$337.10
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Devoted Health Medicare |
$370.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.10
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$404.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$404.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$404.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.10
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 75573 26
|
| Min. Negotiated Rate |
$120.62 |
| Max. Negotiated Rate |
$204.87 |
| Rate for Payer: AlohaCare Medicaid |
$204.87
|
| Rate for Payer: AlohaCare Medicare |
$120.62
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$132.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.62
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.62
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 75573 TC
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: AlohaCare Medicaid |
$204.87
|
| Rate for Payer: AlohaCare Medicare |
$216.48
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Devoted Health Medicare |
$238.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.48
|
| Rate for Payer: Health Management Network Commercial |
$324.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$259.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.48
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$154.14 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: AlohaCare Medicaid |
$154.14
|
| Rate for Payer: AlohaCare Medicare |
$251.21
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Devoted Health Medicare |
$276.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.21
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.21
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
HCPCS 75572 TC
|
| Min. Negotiated Rate |
$154.14 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: AlohaCare Medicaid |
$154.14
|
| Rate for Payer: AlohaCare Medicare |
$169.20
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Devoted Health Medicare |
$186.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.20
|
| Rate for Payer: Health Management Network Commercial |
$253.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$203.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.20
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 75572 26
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$154.14 |
| Rate for Payer: AlohaCare Medicaid |
$154.14
|
| Rate for Payer: AlohaCare Medicare |
$82.01
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$90.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.01
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.01
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 75571 TC
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$68.14
|
| Rate for Payer: AlohaCare Medicare |
$82.42
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$90.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.48
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.42
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Min. Negotiated Rate |
$27.21 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: AlohaCare Medicaid |
$68.14
|
| Rate for Payer: AlohaCare Medicare |
$27.21
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$29.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.48
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.21
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: AlohaCare Medicaid |
$68.14
|
| Rate for Payer: AlohaCare Medicare |
$109.63
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Devoted Health Medicare |
$120.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.48
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.63
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$144.50
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Devoted Health Medicare |
$158.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$345.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.50
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 76380 26
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$207.33 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$45.19
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Devoted Health Medicare |
$49.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.19
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 76380 TC
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$99.31
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Devoted Health Medicare |
$109.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.31
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$377.36 |
| Rate for Payer: AlohaCare Medicaid |
$114.76
|
| Rate for Payer: AlohaCare Medicare |
$184.66
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Devoted Health Medicare |
$203.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.36
|
| Rate for Payer: Health Management Network Commercial |
$274.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.66
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 72132 26
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$377.36 |
| Rate for Payer: AlohaCare Medicaid |
$114.76
|
| Rate for Payer: AlohaCare Medicare |
$57.05
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Devoted Health Medicare |
$62.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.36
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.05
|
|
