|
CHG LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 88302
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: AlohaCare Medicaid |
$22.33
|
| Rate for Payer: AlohaCare Medicare |
$35.87
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Devoted Health Medicare |
$39.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.15
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.87
|
|
|
CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: AlohaCare Medicaid |
$46.87
|
| Rate for Payer: AlohaCare Medicare |
$39.69
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$43.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.43
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.69
|
|
|
CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 88305 26
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$71.43 |
| Rate for Payer: AlohaCare Medicaid |
$46.87
|
| Rate for Payer: AlohaCare Medicare |
$36.35
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$39.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.43
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.35
|
|
|
CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 88305
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$46.87
|
| Rate for Payer: AlohaCare Medicare |
$76.04
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$83.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.43
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.04
|
|
|
CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$1,329.00
|
|
|
Service Code
|
HCPCS 88309
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$1,129.65 |
| Rate for Payer: AlohaCare Medicaid |
$288.48
|
| Rate for Payer: AlohaCare Medicare |
$455.80
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Devoted Health Medicare |
$501.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$455.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.48
|
| Rate for Payer: Health Management Network Commercial |
$1,129.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$546.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$546.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$546.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$455.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$455.80
|
|
|
CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 88309 26
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$288.48 |
| Rate for Payer: AlohaCare Medicaid |
$288.48
|
| Rate for Payer: AlohaCare Medicare |
$139.62
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Devoted Health Medicare |
$153.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.48
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.62
|
|
|
CHG LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 88309 TC
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: AlohaCare Medicaid |
$288.48
|
| Rate for Payer: AlohaCare Medicare |
$316.17
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Devoted Health Medicare |
$347.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.48
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.17
|
|
|
CHG LIPID PANEL
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: AlohaCare Medicaid |
$18.51
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.50
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
|
|
CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 75801 26
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: AlohaCare Medicaid |
$210.73
|
| Rate for Payer: AlohaCare Medicare |
$43.90
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$48.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$283.00
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.90
|
|
|
CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 75801
|
| Min. Negotiated Rate |
$210.73 |
| Max. Negotiated Rate |
$1,149.20 |
| Rate for Payer: AlohaCare Medicaid |
$210.73
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$283.00
|
| Rate for Payer: Health Management Network Commercial |
$1,149.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.73
|
|
|
CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 75801 TC
|
| Min. Negotiated Rate |
$210.73 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: AlohaCare Medicaid |
$210.73
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$283.00
|
| Rate for Payer: Health Management Network Commercial |
$1,088.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.73
|
|
|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 78195 26
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$236.90 |
| Rate for Payer: AlohaCare Medicaid |
$217.85
|
| Rate for Payer: AlohaCare Medicare |
$54.29
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$59.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.90
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.29
|
|
|
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 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 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
|
$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 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 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 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 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 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 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
|
|
