|
CHG COAGULATION TIME ACTIVATED
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 85347
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$5.88
|
| Rate for Payer: AlohaCare Medicare |
$4.28
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.88
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.28
|
|
|
CHG COMPREHENSIVE METABOLIC PANEL
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 80053
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: AlohaCare Medicaid |
$14.61
|
| Rate for Payer: AlohaCare Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.56
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$289.63 |
| Rate for Payer: AlohaCare Medicaid |
$92.92
|
| Rate for Payer: AlohaCare Medicare |
$98.37
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Devoted Health Medicare |
$108.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.63
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.37
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 71271 26
|
| Min. Negotiated Rate |
$50.28 |
| Max. Negotiated Rate |
$289.63 |
| Rate for Payer: AlohaCare Medicaid |
$92.92
|
| Rate for Payer: AlohaCare Medicare |
$50.28
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Devoted Health Medicare |
$55.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.63
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.28
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 71271
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$357.85 |
| Rate for Payer: AlohaCare Medicaid |
$92.92
|
| Rate for Payer: AlohaCare Medicare |
$148.65
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Devoted Health Medicare |
$163.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.63
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.65
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 88323
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: AlohaCare Medicaid |
$73.37
|
| Rate for Payer: AlohaCare Medicare |
$119.84
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Devoted Health Medicare |
$131.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.70
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.84
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 88323 TC
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: AlohaCare Medicaid |
$73.37
|
| Rate for Payer: AlohaCare Medicare |
$33.61
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Devoted Health Medicare |
$36.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.70
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.61
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 88323 26
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: AlohaCare Medicaid |
$73.37
|
| Rate for Payer: AlohaCare Medicare |
$86.23
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$94.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.70
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.23
|
|
|
CHG CONSLTJ&REPRT REFERRED SLIDES PREPARED ELSEWHERE
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 88321
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: AlohaCare Medicaid |
$50.20
|
| Rate for Payer: AlohaCare Medicare |
$68.13
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Devoted Health Medicare |
$74.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.05
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.13
|
| Rate for Payer: University Health Alliance Commercial |
$102.85
|
|
|
CHG CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 76140
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.05 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
|
|
CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID
|
Professional
|
Both
|
$32.01
|
|
|
Service Code
|
HCPCS 89060
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$27.21 |
| Rate for Payer: AlohaCare Medicaid |
$9.88
|
| Rate for Payer: AlohaCare Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Devoted Health Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.88
|
| Rate for Payer: Health Management Network Commercial |
$27.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.33
|
|
|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Min. Negotiated Rate |
$260.30 |
| Max. Negotiated Rate |
$571.18 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$314.84
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Devoted Health Medicare |
$346.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$314.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.18
|
| Rate for Payer: Health Management Network Commercial |
$468.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$377.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$377.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$377.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$314.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$314.84
|
|
|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 74174 26
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$571.18 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$102.43
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Devoted Health Medicare |
$112.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.18
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.43
|
|
|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$260.30 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$417.27
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Devoted Health Medicare |
$459.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$417.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.18
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$500.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$417.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$417.27
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 74177 26
|
| Min. Negotiated Rate |
$85.17 |
| Max. Negotiated Rate |
$393.28 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$85.17
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Devoted Health Medicare |
$93.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.17
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$207.63 |
| Max. Negotiated Rate |
$829.60 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$330.89
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Devoted Health Medicare |
$363.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$829.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.89
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Min. Negotiated Rate |
$207.63 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: AlohaCare Medicaid |
$207.63
|
| Rate for Payer: AlohaCare Medicare |
$245.72
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Devoted Health Medicare |
$270.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.28
|
| Rate for Payer: Health Management Network Commercial |
$702.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.72
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 74176 26
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$81.31
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$89.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.31
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Min. Negotiated Rate |
$116.98 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$116.98
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Devoted Health Medicare |
$128.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.98
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 74176
|
| Min. Negotiated Rate |
$122.73 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: AlohaCare Medicaid |
$122.73
|
| Rate for Payer: AlohaCare Medicare |
$198.28
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Devoted Health Medicare |
$218.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.66
|
| Rate for Payer: Health Management Network Commercial |
$453.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.28
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 74150 26
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$313.29 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$55.67
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$61.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.67
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$313.29 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$92.48
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Devoted Health Medicare |
$101.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.48
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: AlohaCare Medicaid |
$92.02
|
| Rate for Payer: AlohaCare Medicare |
$148.15
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Devoted Health Medicare |
$162.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.29
|
| Rate for Payer: Health Management Network Commercial |
$345.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.15
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 74178 26
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$499.94 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$94.37
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Devoted Health Medicare |
$103.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.94
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.37
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Min. Negotiated Rate |
$232.99 |
| Max. Negotiated Rate |
$499.94 |
| Rate for Payer: AlohaCare Medicaid |
$232.99
|
| Rate for Payer: AlohaCare Medicare |
$278.19
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Devoted Health Medicare |
$306.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.94
|
| Rate for Payer: Health Management Network Commercial |
$414.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.19
|
|
