|
CHG BILIRUBIN TOTAL TRANSCUTANEOUS
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 88720
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: AlohaCare Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$5.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.02
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.02
|
|
|
CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 85025
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: AlohaCare Medicaid |
$10.74
|
| Rate for Payer: AlohaCare Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.77
|
|
|
CHG BLOOD COUNT HEMOGLOBIN
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS 85018
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: AlohaCare Medicaid |
$3.27
|
| Rate for Payer: AlohaCare Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.37
|
|
|
CHG BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 82803
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: AlohaCare Medicaid |
$26.74
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.75
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 82272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$4.54
|
| Rate for Payer: AlohaCare Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.53
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.23
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 82270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: AlohaCare Medicaid |
$4.49
|
| Rate for Payer: AlohaCare Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$4.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.50
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.38
|
|
|
CHG BONE MARROW SMEAR INTERPRETATION
|
Professional
|
Both
|
$125.91
|
|
|
Service Code
|
HCPCS 85097
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$107.02 |
| Rate for Payer: AlohaCare Medicaid |
$28.97
|
| Rate for Payer: AlohaCare Medicare |
$39.29
|
| Rate for Payer: Cash Price |
$75.55
|
| Rate for Payer: Cash Price |
$75.55
|
| Rate for Payer: Devoted Health Medicare |
$43.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.40
|
| Rate for Payer: Health Management Network Commercial |
$107.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.29
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$88.13
|
|
|
Service Code
|
HCPCS 75565
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$50.36
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Devoted Health Medicare |
$55.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.36
|
| Rate for Payer: Health Management Network Commercial |
$74.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.36
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 75565 TC
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$38.74
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$42.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.74
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.74
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 75565 26
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$31.27 |
| Rate for Payer: AlohaCare Medicaid |
$31.27
|
| Rate for Payer: AlohaCare Medicare |
$11.63
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.63
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.63
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 75557 TC
|
| Min. Negotiated Rate |
$188.49 |
| Max. Negotiated Rate |
$292.40 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$195.21
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Devoted Health Medicare |
$214.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.21
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$234.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.21
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75557 26
|
| Min. Negotiated Rate |
$110.13 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$110.13
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Devoted Health Medicare |
$121.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.13
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.13
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 75557
|
| Min. Negotiated Rate |
$188.49 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: AlohaCare Medicaid |
$188.49
|
| Rate for Payer: AlohaCare Medicare |
$305.34
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Devoted Health Medicare |
$335.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$305.34
|
| Rate for Payer: Health Management Network Commercial |
$453.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$366.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.34
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 75559 TC
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$278.00
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Devoted Health Medicare |
$305.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.00
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.00
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 75559 26
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$254.75 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$138.95
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$152.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.95
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.95
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 75559
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: AlohaCare Medicaid |
$254.75
|
| Rate for Payer: AlohaCare Medicare |
$416.95
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Devoted Health Medicare |
$458.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$416.95
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$500.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.95
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 75561
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$400.67
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Devoted Health Medicare |
$440.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.67
|
| Rate for Payer: Health Management Network Commercial |
$595.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.67
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 75561 26
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$247.87 |
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$122.48
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Devoted Health Medicare |
$134.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.48
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.48
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 75561 TC
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: AlohaCare Medicaid |
$247.87
|
| Rate for Payer: AlohaCare Medicare |
$278.19
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Devoted Health Medicare |
$306.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.19
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.19
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 75563 26
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$289.36 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$141.20
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$155.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.20
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.20
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 75563
|
| Min. Negotiated Rate |
$289.36 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$472.56
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Devoted Health Medicare |
$519.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.56
|
| Rate for Payer: Health Management Network Commercial |
$702.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$567.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$567.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.56
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 75563 TC
|
| Min. Negotiated Rate |
$289.36 |
| Max. Negotiated Rate |
$498.10 |
| Rate for Payer: AlohaCare Medicaid |
$289.36
|
| Rate for Payer: AlohaCare Medicare |
$331.36
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Devoted Health Medicare |
$364.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.36
|
| Rate for Payer: Health Management Network Commercial |
$498.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.36
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 75984
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$101.70
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Devoted Health Medicare |
$111.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$236.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.70
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$64.37
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Devoted Health Medicare |
$70.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.37
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 75984 26
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$125.41 |
| Rate for Payer: AlohaCare Medicaid |
$62.34
|
| Rate for Payer: AlohaCare Medicare |
$37.33
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$41.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.41
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.33
|
|
