|
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 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
|
$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 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 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
|
$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 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 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
|
$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
|
$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
|
$502.00
|
|
|
Service Code
|
HCPCS 73206
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$570.76 |
| Rate for Payer: AlohaCare Medicaid |
$202.84
|
| Rate for Payer: AlohaCare Medicare |
$325.43
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Devoted Health Medicare |
$357.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$325.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.76
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$325.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$325.43
|
|
|
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
|
$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 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
|
$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 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
|
$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 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
|
$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 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 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
|
|
