|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$121.43
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Devoted Health Medicare |
$133.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.43
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 75825 26
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$51.74
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$56.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.74
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75827 26
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$52.31
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$57.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.31
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$75.01
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$82.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.01
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$76.66 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$127.32
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$140.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.32
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Min. Negotiated Rate |
$74.63 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Devoted Health Medicare |
$82.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.63
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$142.33
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Devoted Health Medicare |
$156.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$304.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.33
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 75822 26
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$122.37 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$67.70
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Devoted Health Medicare |
$74.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.70
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$67.03
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Devoted Health Medicare |
$73.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.03
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$115.56
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Devoted Health Medicare |
$127.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.56
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 75820 26
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$80.24 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$48.53
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Devoted Health Medicare |
$53.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.53
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$636.14 |
| Rate for Payer: AlohaCare Medicaid |
$94.99
|
| Rate for Payer: AlohaCare Medicare |
$167.38
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Devoted Health Medicare |
$184.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.14
|
| Rate for Payer: Health Management Network Commercial |
$249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.38
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 75833 26
|
| Min. Negotiated Rate |
$71.29 |
| Max. Negotiated Rate |
$636.14 |
| Rate for Payer: AlohaCare Medicaid |
$94.99
|
| Rate for Payer: AlohaCare Medicare |
$71.29
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$78.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.14
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.29
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 75833 TC
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$636.14 |
| Rate for Payer: AlohaCare Medicaid |
$94.99
|
| Rate for Payer: AlohaCare Medicare |
$96.09
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Devoted Health Medicare |
$105.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.14
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.09
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 75831 26
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$616.67 |
| Rate for Payer: AlohaCare Medicaid |
$77.47
|
| Rate for Payer: AlohaCare Medicare |
$50.21
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Devoted Health Medicare |
$55.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.67
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.21
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 75831 TC
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$616.67 |
| Rate for Payer: AlohaCare Medicaid |
$77.47
|
| Rate for Payer: AlohaCare Medicare |
$77.86
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$85.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.67
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.86
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$616.67 |
| Rate for Payer: AlohaCare Medicaid |
$77.47
|
| Rate for Payer: AlohaCare Medicare |
$128.07
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Devoted Health Medicare |
$140.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.67
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.07
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$81.60
|
| Rate for Payer: AlohaCare Medicare |
$139.85
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Devoted Health Medicare |
$153.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.85
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$81.60
|
| Rate for Payer: AlohaCare Medicare |
$86.21
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Devoted Health Medicare |
$94.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.21
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 75860 26
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$81.60
|
| Rate for Payer: AlohaCare Medicare |
$53.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$58.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.63
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$744,903.30
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$491,172.19 |
| Max. Negotiated Rate |
$744,903.30 |
| Rate for Payer: AlohaCare Medicare |
$491,172.19
|
| Rate for Payer: Devoted Health Medicare |
$540,289.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$491,172.19
|
| Rate for Payer: Humana Medicare |
$491,172.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$744,903.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$491,172.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$491,172.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$491,172.19
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 00555003302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 00555003302
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687080701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
