|
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$218.29 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: AlohaCare Medicaid |
$218.29
|
| Rate for Payer: AlohaCare Medicare |
$356.58
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Devoted Health Medicare |
$392.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.58
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$427.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$427.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$427.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.58
|
|
|
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$260.30 |
| Max. Negotiated Rate |
$1,058.25 |
| Rate for Payer: AlohaCare Medicaid |
$260.30
|
| Rate for Payer: AlohaCare Medicare |
$417.27
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| 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 |
$1,058.25
|
| 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
|
|
|
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 74175
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$693.60 |
| Rate for Payer: AlohaCare Medicaid |
$209.00
|
| Rate for Payer: AlohaCare Medicare |
$335.26
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$368.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$335.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$622.29
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$402.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$402.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$335.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$335.26
|
|
|
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$191.79 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: AlohaCare Medicaid |
$191.79
|
| Rate for Payer: AlohaCare Medicare |
$308.30
|
| Rate for Payer: Cash Price |
$531.70
|
| Rate for Payer: Cash Price |
$531.70
|
| Rate for Payer: Devoted Health Medicare |
$339.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.86
|
| Rate for Payer: Health Management Network Commercial |
$695.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$369.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.30
|
|
|
CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 70496
|
| Min. Negotiated Rate |
$188.21 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: AlohaCare Medicaid |
$188.21
|
| Rate for Payer: AlohaCare Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$525.20
|
| Rate for Payer: Cash Price |
$525.20
|
| Rate for Payer: Devoted Health Medicare |
$331.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$301.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$425.61
|
| Rate for Payer: Health Management Network Commercial |
$686.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$301.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$301.35
|
|
|
CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 70498
|
| Min. Negotiated Rate |
$187.99 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: AlohaCare Medicaid |
$187.99
|
| Rate for Payer: AlohaCare Medicare |
$301.35
|
| Rate for Payer: Cash Price |
$525.20
|
| Rate for Payer: Cash Price |
$525.20
|
| Rate for Payer: Devoted Health Medicare |
$331.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$301.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$559.66
|
| Rate for Payer: Health Management Network Commercial |
$686.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$361.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$301.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$301.35
|
|
|
CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 72126
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$465.80 |
| Rate for Payer: AlohaCare Medicaid |
$114.53
|
| Rate for Payer: AlohaCare Medicare |
$184.28
|
| Rate for Payer: Cash Price |
$356.20
|
| Rate for Payer: Cash Price |
$356.20
|
| Rate for Payer: Devoted Health Medicare |
$202.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.25
|
| Rate for Payer: Health Management Network Commercial |
$465.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.28
|
|
|
CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$357.85 |
| Rate for Payer: AlohaCare Medicaid |
$88.11
|
| Rate for Payer: AlohaCare Medicare |
$142.70
|
| Rate for Payer: Cash Price |
$273.65
|
| Rate for Payer: Cash Price |
$273.65
|
| Rate for Payer: Devoted Health Medicare |
$156.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.70
|
|
|
CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: AlohaCare Medicaid |
$100.46
|
| Rate for Payer: AlohaCare Medicare |
$161.91
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$178.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.50
|
| Rate for Payer: Health Management Network Commercial |
$408.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.91
|
|
|
CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: AlohaCare Medicaid |
$71.70
|
| Rate for Payer: AlohaCare Medicare |
$116.23
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Devoted Health Medicare |
$127.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.45
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.23
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: AlohaCare Medicaid |
$117.71
|
| Rate for Payer: AlohaCare Medicare |
$189.37
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Cash Price |
$367.25
|
| Rate for Payer: Devoted Health Medicare |
$208.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.45
|
| Rate for Payer: Health Management Network Commercial |
$480.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.37
|
|
|
CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$154.14 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: AlohaCare Medicaid |
$154.14
|
| Rate for Payer: AlohaCare Medicare |
$251.21
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| 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 |
$625.60
|
| 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
|
|
|
CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: AlohaCare Medicaid |
$68.14
|
| Rate for Payer: AlohaCare Medicare |
$109.63
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| 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 |
$272.00
|
| 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
|
|
|
CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$144.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| 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 |
$331.50
|
| 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
|
|
|
CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$113.33 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: AlohaCare Medicaid |
$113.33
|
| Rate for Payer: AlohaCare Medicare |
$181.90
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Devoted Health Medicare |
$200.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.90
|
|
|
CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$356.15 |
| Rate for Payer: AlohaCare Medicaid |
$87.65
|
| Rate for Payer: AlohaCare Medicare |
$142.32
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Devoted Health Medicare |
$156.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.05
|
| Rate for Payer: Health Management Network Commercial |
$356.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.32
|
|
|
CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$466.65 |
| Rate for Payer: AlohaCare Medicaid |
$114.76
|
| Rate for Payer: AlohaCare Medicare |
$184.66
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Cash Price |
$356.85
|
| 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 |
$466.65
|
| 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
|
|
|
CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$356.15 |
| Rate for Payer: AlohaCare Medicaid |
$87.42
|
| Rate for Payer: AlohaCare Medicare |
$141.94
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Cash Price |
$272.35
|
| Rate for Payer: Devoted Health Medicare |
$156.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$356.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.94
|
|
|
CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$165.70
|
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Cash Price |
$320.45
|
| 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 |
$419.05
|
| 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
|
|
|
CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$140.91
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$268.45
|
| 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 |
$351.05
|
| 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
|
|
|
CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: AlohaCare Medicaid |
$125.28
|
| Rate for Payer: AlohaCare Medicare |
$201.90
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$222.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$388.55
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.90
|
|
|
CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$498.10 |
| Rate for Payer: AlohaCare Medicaid |
$123.29
|
| Rate for Payer: AlohaCare Medicare |
$197.60
|
| Rate for Payer: Cash Price |
$380.90
|
| Rate for Payer: Cash Price |
$380.90
|
| Rate for Payer: Devoted Health Medicare |
$217.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$498.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.60
|
|
|
CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$436.90 |
| Rate for Payer: AlohaCare Medicaid |
$107.35
|
| Rate for Payer: AlohaCare Medicare |
$172.61
|
| Rate for Payer: Cash Price |
$334.10
|
| Rate for Payer: Cash Price |
$334.10
|
| Rate for Payer: Devoted Health Medicare |
$189.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$436.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.61
|
|
|
CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$144.10 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: AlohaCare Medicaid |
$144.10
|
| Rate for Payer: AlohaCare Medicare |
$230.38
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Devoted Health Medicare |
$253.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.38
|
|
|
CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$157.39 |
| Max. Negotiated Rate |
$611.15 |
| Rate for Payer: AlohaCare Medicaid |
$157.39
|
| Rate for Payer: AlohaCare Medicare |
$249.88
|
| Rate for Payer: Cash Price |
$467.35
|
| Rate for Payer: Cash Price |
$467.35
|
| Rate for Payer: Devoted Health Medicare |
$274.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$364.03
|
| Rate for Payer: Health Management Network Commercial |
$611.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$299.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$299.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$157.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$157.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.88
|
|
