|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 88172 26
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$34.34
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$37.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.34
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 88177 TC
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$9.87
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$10.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.87
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 88177
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$30.98
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$34.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.98
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 88177 26
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$21.10
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.10
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 88104 26
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$50.07 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$27.68
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.68
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 88104 TC
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$64.95
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$71.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.95
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 88104
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$92.63
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$101.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.63
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 88160
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$89.86
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Devoted Health Medicare |
$98.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.86
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 88160 26
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$53.01 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.91
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$64.95
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Devoted Health Medicare |
$71.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.95
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$378.67 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$127.99
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$140.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.99
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 71260 26
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$378.67 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$54.67
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Devoted Health Medicare |
$60.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.67
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$182.66
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Devoted Health Medicare |
$200.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.66
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| Rate for Payer: AlohaCare Medicare |
$94.38
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Devoted Health Medicare |
$103.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.38
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 71250 26
|
| Min. Negotiated Rate |
$50.28 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| 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 |
$322.87
|
| 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 |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.28
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| Rate for Payer: AlohaCare Medicare |
$144.66
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Devoted Health Medicare |
$159.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.66
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 74485 26
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$168.38 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$40.55
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$44.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.55
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$95.52
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Devoted Health Medicare |
$105.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$251.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.52
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 74485
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$136.06
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Devoted Health Medicare |
$149.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.06
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: AlohaCare Medicaid |
$8.98
|
| Rate for Payer: AlohaCare Medicare |
$12.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.95
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.60
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: AlohaCare Medicaid |
$47.89
|
| Rate for Payer: AlohaCare Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$68.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.14
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 74328 26
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$177.24 |
| Rate for Payer: AlohaCare Medicaid |
$131.53
|
| Rate for Payer: AlohaCare Medicare |
$24.87
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.24
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.87
|
|
|
CHG EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 84112
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: AlohaCare Medicaid |
$90.64
|
| Rate for Payer: AlohaCare Medicare |
$98.11
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Devoted Health Medicare |
$107.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.11
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.11
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 76818 TC
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: AlohaCare Medicaid |
$77.98
|
| Rate for Payer: AlohaCare Medicare |
$81.28
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Devoted Health Medicare |
$89.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.66
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.28
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$294.10 |
| Rate for Payer: AlohaCare Medicaid |
$77.98
|
| Rate for Payer: AlohaCare Medicare |
$132.64
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$145.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.66
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.64
|
|
