|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 78195 TC
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: AlohaCare Medicaid |
$217.85
|
| Rate for Payer: AlohaCare Medicare |
$292.63
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Devoted Health Medicare |
$321.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$292.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.90
|
| Rate for Payer: Health Management Network Commercial |
$835.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$351.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$351.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$292.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$292.63
|
|
|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 78195
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$916.30 |
| Rate for Payer: AlohaCare Medicaid |
$217.85
|
| Rate for Payer: AlohaCare Medicare |
$346.92
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Devoted Health Medicare |
$381.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$346.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.90
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$416.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$346.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$346.92
|
|
|
CHG MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY
|
Professional
|
Both
|
$110.81
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: AlohaCare Medicaid |
$35.82
|
| Rate for Payer: AlohaCare Medicare |
$63.32
|
| Rate for Payer: Cash Price |
$66.49
|
| Rate for Payer: Cash Price |
$66.49
|
| Rate for Payer: Devoted Health Medicare |
$69.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.32
|
| Rate for Payer: Health Management Network Commercial |
$94.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.32
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: AlohaCare Medicaid |
$58.72
|
| Rate for Payer: AlohaCare Medicare |
$95.31
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Devoted Health Medicare |
$104.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.31
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.31
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 75902 26
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: AlohaCare Medicaid |
$58.72
|
| Rate for Payer: AlohaCare Medicare |
$18.02
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$19.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.02
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.02
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 75902 TC
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: AlohaCare Medicaid |
$58.72
|
| Rate for Payer: AlohaCare Medicare |
$77.29
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Devoted Health Medicare |
$85.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.29
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.29
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 75901 TC
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$347.65 |
| Rate for Payer: AlohaCare Medicaid |
$154.46
|
| Rate for Payer: AlohaCare Medicare |
$233.18
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Devoted Health Medicare |
$256.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$233.18
|
| Rate for Payer: Health Management Network Commercial |
$347.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$279.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$233.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$233.18
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 75901 26
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$154.46 |
| Rate for Payer: AlohaCare Medicaid |
$154.46
|
| Rate for Payer: AlohaCare Medicare |
$22.50
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Devoted Health Medicare |
$24.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.50
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.50
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$379.95 |
| Rate for Payer: AlohaCare Medicaid |
$154.46
|
| Rate for Payer: AlohaCare Medicare |
$255.69
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Devoted Health Medicare |
$281.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.69
|
| Rate for Payer: Health Management Network Commercial |
$379.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.69
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 88377 26
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$267.53 |
| Rate for Payer: AlohaCare Medicaid |
$267.53
|
| Rate for Payer: AlohaCare Medicare |
$62.66
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$68.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$240.10
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.66
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 88377
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: AlohaCare Medicaid |
$267.53
|
| Rate for Payer: AlohaCare Medicare |
$429.72
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Devoted Health Medicare |
$472.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$240.10
|
| Rate for Payer: Health Management Network Commercial |
$1,130.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$515.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$515.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.72
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$1,037.85 |
| Rate for Payer: AlohaCare Medicaid |
$267.53
|
| Rate for Payer: AlohaCare Medicare |
$367.06
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Devoted Health Medicare |
$403.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$240.10
|
| Rate for Payer: Health Management Network Commercial |
$1,037.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$440.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.06
|
|
|
CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: AlohaCare Medicaid |
$80.08
|
| Rate for Payer: AlohaCare Medicare |
$92.10
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Devoted Health Medicare |
$101.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.45
|
| Rate for Payer: Health Management Network Commercial |
$251.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.10
|
|
|
CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 88360
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: AlohaCare Medicaid |
$80.08
|
| Rate for Payer: AlohaCare Medicare |
$132.55
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Devoted Health Medicare |
$145.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.45
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.55
|
|
|
CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 88360 26
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$117.45 |
| Rate for Payer: AlohaCare Medicaid |
$80.08
|
| Rate for Payer: AlohaCare Medicare |
$40.45
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$44.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.45
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.45
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 74183 26
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$103.19
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$113.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.19
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 74183 TC
|
| Min. Negotiated Rate |
$231.16 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$266.04
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Devoted Health Medicare |
$292.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.04
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$231.16 |
| Max. Negotiated Rate |
$1,211.34 |
| Rate for Payer: AlohaCare Medicaid |
$231.16
|
| Rate for Payer: AlohaCare Medicare |
$369.23
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Devoted Health Medicare |
$406.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,211.34
|
| Rate for Payer: Health Management Network Commercial |
$549.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.23
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Min. Negotiated Rate |
$138.58 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$161.03
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Devoted Health Medicare |
$177.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$239.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.03
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$138.58 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$225.46
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Devoted Health Medicare |
$248.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$335.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$270.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$270.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.46
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 73221 26
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$565.39 |
| Rate for Payer: AlohaCare Medicaid |
$138.58
|
| Rate for Payer: AlohaCare Medicare |
$64.43
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$70.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.39
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.43
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$266.19 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$423.19
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Devoted Health Medicare |
$465.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$629.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$507.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.19
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 73223 26
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$101.32
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Devoted Health Medicare |
$111.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.32
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 73223 TC
|
| Min. Negotiated Rate |
$266.19 |
| Max. Negotiated Rate |
$1,201.84 |
| Rate for Payer: AlohaCare Medicaid |
$266.19
|
| Rate for Payer: AlohaCare Medicare |
$321.86
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Devoted Health Medicare |
$354.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,201.84
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$386.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.86
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$574.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.26
|
| Rate for Payer: AlohaCare Medicare |
$144.70
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Devoted Health Medicare |
$159.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.09
|
| Rate for Payer: Health Management Network Commercial |
$215.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.70
|
|
