|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$18,511.26
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$18,511.26 |
| Max. Negotiated Rate |
$18,511.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,511.26
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$18,511.26
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$18,511.26 |
| Max. Negotiated Rate |
$18,511.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,511.26
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,511.26
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$18,511.26 |
| Max. Negotiated Rate |
$18,511.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,511.26
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$11,448.07
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$11,448.07 |
| Max. Negotiated Rate |
$11,448.07 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11,448.07
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 76377 26
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: AlohaCare Medicaid |
$50.53
|
| Rate for Payer: AlohaCare Medicare |
$37.70
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$188.71
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.70
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 76377 TC
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: AlohaCare Medicaid |
$50.53
|
| Rate for Payer: AlohaCare Medicare |
$47.10
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$51.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$188.71
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.10
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: AlohaCare Medicaid |
$50.53
|
| Rate for Payer: AlohaCare Medicare |
$84.80
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Devoted Health Medicare |
$93.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$188.71
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.80
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 76376 TC
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: AlohaCare Medicaid |
$16.38
|
| Rate for Payer: AlohaCare Medicare |
$18.04
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$19.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.85
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.04
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 76376 26
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: AlohaCare Medicaid |
$16.38
|
| Rate for Payer: AlohaCare Medicare |
$9.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.85
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.53
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: AlohaCare Medicaid |
$16.38
|
| Rate for Payer: AlohaCare Medicare |
$27.57
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Devoted Health Medicare |
$30.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.85
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.57
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 75716 TC
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$103.42
|
| Rate for Payer: AlohaCare Medicare |
$82.04
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Devoted Health Medicare |
$90.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.04
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$103.42
|
| Rate for Payer: AlohaCare Medicare |
$171.87
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Devoted Health Medicare |
$189.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.87
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 75716 26
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$626.28 |
| Rate for Payer: AlohaCare Medicaid |
$103.42
|
| Rate for Payer: AlohaCare Medicare |
$89.84
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Devoted Health Medicare |
$98.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.28
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.84
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$157.27
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Devoted Health Medicare |
$173.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$328.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$188.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$188.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.27
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$77.86
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$85.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.86
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 75710 26
|
| Min. Negotiated Rate |
$79.41 |
| Max. Negotiated Rate |
$616.96 |
| Rate for Payer: AlohaCare Medicaid |
$95.12
|
| Rate for Payer: AlohaCare Medicare |
$79.41
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$87.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.96
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.41
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 75756 26
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$54.21
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Devoted Health Medicare |
$59.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.21
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$182.39
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Devoted Health Medicare |
$200.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.39
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75756 TC
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$618.50 |
| Rate for Payer: AlohaCare Medicaid |
$108.56
|
| Rate for Payer: AlohaCare Medicare |
$128.18
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$141.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.50
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.18
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 75736 TC
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$105.40
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Devoted Health Medicare |
$115.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.40
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$155.79
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Devoted Health Medicare |
$171.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$370.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.79
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 75736 26
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$93.88
|
| Rate for Payer: AlohaCare Medicare |
$50.39
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Devoted Health Medicare |
$55.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.39
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Min. Negotiated Rate |
$80.90 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$80.90
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$88.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.90
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$272.90
|
|
|
Service Code
|
HCPCS 75743
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$155.94
|
| Rate for Payer: Cash Price |
$163.74
|
| Rate for Payer: Cash Price |
$163.74
|
| Rate for Payer: Devoted Health Medicare |
$171.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$231.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.94
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 75743 26
|
| Min. Negotiated Rate |
$75.04 |
| Max. Negotiated Rate |
$645.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.85
|
| Rate for Payer: AlohaCare Medicare |
$75.04
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Devoted Health Medicare |
$82.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.23
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.04
|
|
