|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 75557 TC
|
| Min. Negotiated Rate |
$188.49 |
| Max. Negotiated Rate |
$292.40 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$195.21
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Devoted Health Medicare |
$214.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.21
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$234.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.21
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 75559 26
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$138.95
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$152.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.95
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.95
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 75559 TC
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$278.00
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Devoted Health Medicare |
$305.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.00
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.00
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 75559
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$416.95
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Devoted Health Medicare |
$458.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$416.95
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$500.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.95
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 75561 TC
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$278.19
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Devoted Health Medicare |
$306.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.19
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| 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 |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.19
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 75561
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$400.67
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Devoted Health Medicare |
$440.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.67
|
| Rate for Payer: Health Management Network Commercial |
$595.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.67
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 75561 26
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$247.87 |
| Rate for Payer: Devoted Health Medicare |
$134.73
|
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$122.48
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.48
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.48
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 75563
|
| Min. Negotiated Rate |
$289.36 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$472.56
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Devoted Health Medicare |
$519.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.56
|
| Rate for Payer: Health Management Network Commercial |
$702.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$567.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$567.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.56
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 75563 26
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$289.36 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$141.20
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$155.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.20
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.20
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 75563 TC
|
| Min. Negotiated Rate |
$289.36 |
| Max. Negotiated Rate |
$498.10 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$331.36
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Devoted Health Medicare |
$364.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.36
|
| Rate for Payer: Health Management Network Commercial |
$498.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.36
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 75984
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$101.70
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Devoted Health Medicare |
$111.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$236.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.70
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 75984 26
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$125.41 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$37.33
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$41.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.33
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$64.37
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Devoted Health Medicare |
$70.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.37
|
|
|
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
|
$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
|
$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
|
$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
|
$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 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 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
|
|
