|
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
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$57.73
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$63.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.73
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$95.33
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$104.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.33
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.60
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 88184
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$53.46
|
| Rate for Payer: AlohaCare Medicare |
$91.91
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Devoted Health Medicare |
$101.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.53
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.91
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 88184 TC
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$53.46
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.53
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.46
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 88185 TC
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: AlohaCare Medicaid |
$16.29
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.73
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.29
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 88185
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: AlohaCare Medicaid |
$16.29
|
| Rate for Payer: AlohaCare Medicare |
$26.20
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Devoted Health Medicare |
$28.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.73
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.20
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$28.83
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$31.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.83
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 77003 TC
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Devoted Health Medicare |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.40
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$115.24
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Devoted Health Medicare |
$126.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.24
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 77001 TC
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$91.72
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Devoted Health Medicare |
$100.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$251.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.72
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$109.41
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Devoted Health Medicare |
$120.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.41
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 77001 26
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$89.19 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$17.69
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$19.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.69
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: AlohaCare Medicaid |
$77.78
|
| Rate for Payer: AlohaCare Medicare |
$106.91
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Devoted Health Medicare |
$117.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$276.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.91
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 77002 26
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$80.40 |
| Rate for Payer: AlohaCare Medicaid |
$77.78
|
| Rate for Payer: AlohaCare Medicare |
$27.78
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$30.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.78
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$317.90 |
| Rate for Payer: AlohaCare Medicaid |
$77.78
|
| Rate for Payer: AlohaCare Medicare |
$134.69
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Devoted Health Medicare |
$148.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.69
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$111.35 |
| Rate for Payer: AlohaCare Medicaid |
$28.01
|
| Rate for Payer: AlohaCare Medicare |
$48.01
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Devoted Health Medicare |
$52.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.25
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.01
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 76000 26
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: AlohaCare Medicaid |
$28.01
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.25
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: AlohaCare Medicaid |
$28.01
|
| Rate for Payer: AlohaCare Medicare |
$32.47
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$35.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.25
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.47
|
|
|
CHG GENERAL HEALTH PANEL
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 80050
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$41.19
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.00
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.19
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$3.28
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$3.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.28
|
|
|
CHG GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 82948
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: AlohaCare Medicaid |
$4.37
|
| Rate for Payer: AlohaCare Medicare |
$5.04
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$5.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.04
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$5.42
|
| Rate for Payer: AlohaCare Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.93
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: AlohaCare Medicaid |
$13.42
|
| Rate for Payer: AlohaCare Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.43
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.71
|
|
