|
CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 87086
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: AlohaCare Medicaid |
$11.16
|
| Rate for Payer: AlohaCare Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.15
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.07
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 74430 26
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 74430 TC
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$30.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$33.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.20
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 74430
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: AlohaCare Medicaid |
$27.15
|
| Rate for Payer: AlohaCare Medicare |
$45.49
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Devoted Health Medicare |
$50.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.49
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 88108
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$75.89
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$83.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.89
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 88108 TC
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$53.74
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| 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 |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| 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 |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.74
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 88108 26
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$45.73 |
| Rate for Payer: AlohaCare Medicaid |
$45.73
|
| Rate for Payer: AlohaCare Medicare |
$22.15
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Devoted Health Medicare |
$24.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.50
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.15
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 88173
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$182.35
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Devoted Health Medicare |
$200.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$430.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.35
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 88173 26
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$67.84
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$74.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.84
|
|
|
CHG CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$110.48
|
| Rate for Payer: AlohaCare Medicare |
$114.51
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Devoted Health Medicare |
$125.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.35
|
| Rate for Payer: Health Management Network Commercial |
$329.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.51
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 88172
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$63.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.08
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 88172 TC
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$26.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.74
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 88172 26
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$34.34
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$37.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.33
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.34
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 88177
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$30.98
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$34.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.98
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 88177 TC
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$9.87
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$10.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.87
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 88177 26
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.83
|
| Rate for Payer: AlohaCare Medicare |
$21.10
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.50
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.10
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 88104
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$92.63
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$101.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.63
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 88104 TC
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$64.95
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$71.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.95
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 88104 26
|
| Min. Negotiated Rate |
$27.68 |
| Max. Negotiated Rate |
$50.07 |
| Rate for Payer: AlohaCare Medicaid |
$50.07
|
| Rate for Payer: AlohaCare Medicare |
$27.68
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.68
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 88160
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$89.86
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Devoted Health Medicare |
$98.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.86
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$64.95
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Devoted Health Medicare |
$71.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.95
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 88160 26
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$53.01 |
| Rate for Payer: AlohaCare Medicaid |
$53.01
|
| Rate for Payer: AlohaCare Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.91
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$378.67 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$127.99
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$140.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.99
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 71260 26
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$378.67 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$54.67
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Devoted Health Medicare |
$60.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.67
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: AlohaCare Medicaid |
$113.56
|
| Rate for Payer: AlohaCare Medicare |
$182.66
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Devoted Health Medicare |
$200.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.67
|
| Rate for Payer: Health Management Network Commercial |
$446.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.66
|
|
