|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$144.70
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Devoted Health Medicare |
$159.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$215.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.70
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70551 26
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$69.01
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$75.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.01
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 70553 26
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$107.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$117.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.00
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 70553 TC
|
| Min. Negotiated Rate |
$216.78 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$240.21
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$264.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.21
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$216.78 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$347.21
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Devoted Health Medicare |
$381.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$515.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$416.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.21
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 72197 TC
|
| Min. Negotiated Rate |
$230.24 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$264.14
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Devoted Health Medicare |
$290.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.14
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 72197 26
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$103.19
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$113.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.19
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$230.24 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$367.33
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Devoted Health Medicare |
$404.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$546.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$440.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.33
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 72141 26
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$69.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$76.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.39
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$208.39
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Devoted Health Medicare |
$229.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$310.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$250.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$250.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.39
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$139.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$152.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.00
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$120.50
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Devoted Health Medicare |
$132.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.50
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 72265 TC
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$79.56
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$87.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.56
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 72265 26
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$40.93
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$45.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.93
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Min. Negotiated Rate |
$291.63 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$400.49
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$440.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.49
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$291.63 |
| Max. Negotiated Rate |
$1,214.65 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$476.83
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Devoted Health Medicare |
$524.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$1,214.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$572.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$572.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.83
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 78452 26
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$430.36 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$76.34
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$83.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.34
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 78451 26
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$64.67
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$71.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.67
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$771.80 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$281.24
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Devoted Health Medicare |
$309.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$771.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$337.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.24
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$1,021.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$345.90
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Devoted Health Medicare |
$380.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$345.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$867.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$415.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$415.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$345.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$345.90
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: AlohaCare Medicaid |
$5.43
|
| Rate for Payer: AlohaCare Medicare |
$4.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$4.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.29
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$81.28
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Devoted Health Medicare |
$89.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.28
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 75885
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$144.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Devoted Health Medicare |
$159.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$325.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.98
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 75885 26
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$63.70
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$70.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.70
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 76080
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$63.48
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$69.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.48
|
|
