|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 74246 26
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$42.51
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Devoted Health Medicare |
$46.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.51
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$105.39
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Devoted Health Medicare |
$115.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.39
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 74240 26
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$102.44 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$38.60
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$42.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.60
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 74240 TC
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$95.52
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| 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 |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.52
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 74240
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$134.11
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Devoted Health Medicare |
$147.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.11
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 74248
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$86.34
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$94.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.34
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 74248 TC
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$91.74 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$53.74
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| 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 |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| 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 |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.74
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 74248 26
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$91.74 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$32.60
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$35.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.60
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 79101 26
|
| Min. Negotiated Rate |
$92.11 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$92.11
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$101.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.11
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.11
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Min. Negotiated Rate |
$60.01 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$60.01
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$66.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.01
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.01
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$152.12
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$167.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.12
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.12
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicare |
$12.35
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$13.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.35
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.35
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.82
|
|
|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 88313
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$90.48
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Devoted Health Medicare |
$99.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.48
|
|
|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 88313 TC
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$78.81
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Devoted Health Medicare |
$86.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.81
|
|
|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 88313 26
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$56.19 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$11.67
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.67
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 88312 26
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$77.75 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$25.87
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.87
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 88312 TC
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$95.71
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Devoted Health Medicare |
$105.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.71
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 88312
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$121.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Devoted Health Medicare |
$133.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.58
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 74283 26
|
| Min. Negotiated Rate |
$105.72 |
| Max. Negotiated Rate |
$222.60 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$105.72
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$116.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.72
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$307.19
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Devoted Health Medicare |
$337.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$457.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.19
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 74283 TC
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$201.47
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Devoted Health Medicare |
$221.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$241.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$241.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.47
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$304.62
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$258.93 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$172.93
|
| Rate for Payer: Cash Price |
$182.77
|
| Rate for Payer: Cash Price |
$182.77
|
| Rate for Payer: Devoted Health Medicare |
$190.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.15
|
| Rate for Payer: Health Management Network Commercial |
$258.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.93
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$193.81
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$164.74 |
| Rate for Payer: AlohaCare Medicaid |
$66.64
|
| Rate for Payer: AlohaCare Medicare |
$110.75
|
| Rate for Payer: Cash Price |
$116.29
|
| Rate for Payer: Cash Price |
$116.29
|
| Rate for Payer: Devoted Health Medicare |
$121.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network Commercial |
$164.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.75
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
|
