|
CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 88360 26
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$117.45 |
| Rate for Payer: AlohaCare Medicaid |
$80.08
|
| Rate for Payer: AlohaCare Medicare |
$40.45
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$44.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.45
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.45
|
|
|
CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 88360
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: AlohaCare Medicaid |
$80.08
|
| Rate for Payer: AlohaCare Medicare |
$132.55
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Devoted Health Medicare |
$145.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.45
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.55
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 74183 TC
|
| Min. Negotiated Rate |
$231.16 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$266.04
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Devoted Health Medicare |
$292.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.04
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 74183 26
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$103.19
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$113.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.19
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$231.16 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$369.23
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Devoted Health Medicare |
$406.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$549.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.23
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 73221 26
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$64.43
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$70.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.43
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$138.58 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$225.46
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Devoted Health Medicare |
$248.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$335.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$270.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$270.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.46
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Min. Negotiated Rate |
$138.58 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$161.03
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Devoted Health Medicare |
$177.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$239.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.03
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 73223 26
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$101.32
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Devoted Health Medicare |
$111.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.32
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 73223 TC
|
| Min. Negotiated Rate |
$266.19 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$321.86
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Devoted Health Medicare |
$354.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$386.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.86
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$266.19 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$423.19
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Devoted Health Medicare |
$465.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$629.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$507.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.19
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 70551 26
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$69.01
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$75.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.01
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$213.71
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Devoted Health Medicare |
$235.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.71
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$144.70
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Devoted Health Medicare |
$159.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$215.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.70
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 70553 26
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$107.00
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$117.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.00
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 70553 TC
|
| Min. Negotiated Rate |
$216.78 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$240.21
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$264.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.21
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$216.78 |
| Max. Negotiated Rate |
$1,225.62 |
| Rate for Payer: AlohaCare Medicaid |
$216.78
|
| Rate for Payer: AlohaCare Medicare |
$347.21
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Devoted Health Medicare |
$381.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,225.62
|
| Rate for Payer: Health Management Network Commercial |
$515.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$416.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.21
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$230.24 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$367.33
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Devoted Health Medicare |
$404.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$546.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$440.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.33
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 72197 TC
|
| Min. Negotiated Rate |
$230.24 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$264.14
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Devoted Health Medicare |
$290.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.14
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 72197 26
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$230.24
|
| Rate for Payer: AlohaCare Medicare |
$103.19
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$113.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.19
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$208.39
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Devoted Health Medicare |
$229.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$310.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$250.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$250.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.39
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 72141 26
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$69.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$76.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.39
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$580.74 |
| Rate for Payer: AlohaCare Medicaid |
$129.36
|
| Rate for Payer: AlohaCare Medicare |
$139.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$152.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.74
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.00
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$120.50
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Devoted Health Medicare |
$132.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.50
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 72265 26
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$40.93
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$45.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.93
|
|
