|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$62.26 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$102.26
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Devoted Health Medicare |
$112.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.26
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 75774 TC
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$57.54
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Devoted Health Medicare |
$63.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.54
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 75774 26
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$574.83 |
| Rate for Payer: AlohaCare Medicaid |
$62.26
|
| Rate for Payer: AlohaCare Medicare |
$44.72
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$49.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.83
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.72
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$163.76
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Devoted Health Medicare |
$180.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.76
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 75630 26
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$90.84
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$99.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.84
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 75630 TC
|
| Min. Negotiated Rate |
$72.92 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.20
|
| Rate for Payer: AlohaCare Medicare |
$72.92
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Devoted Health Medicare |
$80.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.03
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.92
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 75625 TC
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$67.41
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Devoted Health Medicare |
$74.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.41
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$80.11 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$131.91
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Devoted Health Medicare |
$145.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$281.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.91
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 75625 26
|
| Min. Negotiated Rate |
$64.49 |
| Max. Negotiated Rate |
$616.85 |
| Rate for Payer: AlohaCare Medicaid |
$80.11
|
| Rate for Payer: AlohaCare Medicare |
$64.49
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$70.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.85
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.49
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$129.79
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$142.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.79
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75605 26
|
| Min. Negotiated Rate |
$51.93 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$51.93
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$57.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.93
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$617.27 |
| Rate for Payer: AlohaCare Medicaid |
$78.15
|
| Rate for Payer: AlohaCare Medicare |
$77.86
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| 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 |
$617.27
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| 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 |
$78.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.86
|
|
|
CHG BILIRUBIN TOTAL
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 82247
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: AlohaCare Medicaid |
$6.94
|
| Rate for Payer: AlohaCare Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$5.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.95
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.02
|
|
|
CHG BILIRUBIN TOTAL TRANSCUTANEOUS
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 88720
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: AlohaCare Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$5.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.02
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.02
|
|
|
CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 85025
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: AlohaCare Medicaid |
$10.74
|
| Rate for Payer: AlohaCare Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.77
|
|
|
CHG BLOOD COUNT HEMOGLOBIN
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS 85018
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: AlohaCare Medicaid |
$3.27
|
| Rate for Payer: AlohaCare Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.37
|
|
|
CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 82803
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: AlohaCare Medicaid |
$26.74
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.75
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 82272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$4.54
|
| Rate for Payer: AlohaCare Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.53
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.23
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 82270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: AlohaCare Medicaid |
$4.49
|
| Rate for Payer: AlohaCare Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$4.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.50
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.38
|
|
|
CHG BONE MARROW SMEAR INTERPRETATION
|
Professional
|
Both
|
$125.91
|
|
|
Service Code
|
HCPCS 85097
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$107.02 |
| Rate for Payer: AlohaCare Medicaid |
$28.97
|
| Rate for Payer: AlohaCare Medicare |
$39.29
|
| Rate for Payer: Cash Price |
$75.55
|
| Rate for Payer: Cash Price |
$75.55
|
| Rate for Payer: Devoted Health Medicare |
$43.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.40
|
| Rate for Payer: Health Management Network Commercial |
$107.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.29
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 75565 TC
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$38.74
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$42.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.74
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.74
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 75565 26
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$11.63
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.63
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.63
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$88.13
|
|
|
Service Code
|
HCPCS 75565
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$50.36
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Devoted Health Medicare |
$55.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.36
|
| Rate for Payer: Health Management Network Commercial |
$74.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.36
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 75557
|
| Min. Negotiated Rate |
$188.49 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$305.34
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Devoted Health Medicare |
$335.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$305.34
|
| Rate for Payer: Health Management Network Commercial |
$453.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$366.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.34
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75557 26
|
| Min. Negotiated Rate |
$110.13 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$110.13
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Devoted Health Medicare |
$121.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.13
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.13
|
|
