|
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 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
|
$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
|
$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
|
$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
|
|
|
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
|
$223.00
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$377.36 |
| Rate for Payer: AlohaCare Medicaid |
$114.76
|
| Rate for Payer: AlohaCare Medicare |
$127.61
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$140.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.36
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.61
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$165.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Devoted Health Medicare |
$182.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.59
|
| Rate for Payer: Health Management Network Commercial |
$246.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.70
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 70487 26
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$52.91
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$58.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.59
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.91
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 70487 TC
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$112.80
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$124.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.59
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$135.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.80
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$140.91
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Devoted Health Medicare |
$155.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.56
|
| Rate for Payer: Health Management Network Commercial |
$209.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.91
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 70486 TC
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$100.45
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Devoted Health Medicare |
$110.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.56
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.45
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 70486 26
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$40.46
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$44.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.56
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.46
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 70491 26
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| 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 |
$323.80
|
| 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 |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.67
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| Rate for Payer: AlohaCare Medicare |
$200.64
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Devoted Health Medicare |
$220.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.64
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| Rate for Payer: AlohaCare Medicare |
$135.96
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Devoted Health Medicare |
$149.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.96
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$101.04 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$162.93
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Devoted Health Medicare |
$179.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$195.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.93
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Min. Negotiated Rate |
$101.04 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$102.73
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$113.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.73
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 70490 26
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$60.19
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$66.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.19
|
|
