|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$377.36 |
| Rate for Payer: AlohaCare Medicaid |
$114.76
|
| Rate for Payer: AlohaCare Medicare |
$184.66
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| 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 |
$274.55
|
| 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
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 70487 TC
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$112.80
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$124.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.59
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$135.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.80
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 70487 26
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$52.91
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$58.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.59
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.91
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$319.59 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$165.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| 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 |
$246.50
|
| 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
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 70486 TC
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$100.45
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Devoted Health Medicare |
$110.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.56
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.45
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 70486 26
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$40.46
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$44.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.56
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.46
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: AlohaCare Medicaid |
$87.30
|
| Rate for Payer: AlohaCare Medicare |
$140.91
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| 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 |
$209.95
|
| 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
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| Rate for Payer: AlohaCare Medicare |
$135.96
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Devoted Health Medicare |
$149.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.96
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| Rate for Payer: AlohaCare Medicare |
$200.64
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Devoted Health Medicare |
$220.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.64
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 70491 26
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: AlohaCare Medicaid |
$124.95
|
| Rate for Payer: AlohaCare Medicare |
$64.67
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$71.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.67
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 70490 26
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$60.19
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$66.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.19
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Min. Negotiated Rate |
$101.04 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$102.73
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$113.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.73
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$101.04 |
| Max. Negotiated Rate |
$277.62 |
| Rate for Payer: AlohaCare Medicaid |
$101.04
|
| Rate for Payer: AlohaCare Medicare |
$162.93
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Devoted Health Medicare |
$179.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.62
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$195.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.93
|
|
|
CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 87086
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: AlohaCare Medicaid |
$11.16
|
| Rate for Payer: AlohaCare Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.15
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.07
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 74430
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$45.49
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Devoted Health Medicare |
$50.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.49
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 74430 26
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 74430 TC
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$30.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$33.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.20
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 88108 26
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$45.73 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$22.15
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Devoted Health Medicare |
$24.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.15
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 88108
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$75.89
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$83.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.89
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 88108 TC
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$53.74
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$59.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.74
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$114.51
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Devoted Health Medicare |
$125.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$329.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.51
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 88173
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$182.35
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Devoted Health Medicare |
$200.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$430.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.35
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 88173 26
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$74.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.84
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 88172
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$63.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.08
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 88172 TC
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$26.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.74
|
|
