|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| Rate for Payer: AlohaCare Medicare |
$94.38
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Devoted Health Medicare |
$103.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.38
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 71250 26
|
| Min. Negotiated Rate |
$50.28 |
| Max. Negotiated Rate |
$322.87 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| Rate for Payer: AlohaCare Medicare |
$50.28
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Devoted Health Medicare |
$55.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.28
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: AlohaCare Medicaid |
$89.82
|
| Rate for Payer: AlohaCare Medicare |
$144.66
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Devoted Health Medicare |
$159.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.87
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.66
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 74485 26
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$168.38 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$40.55
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$44.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.55
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 74485
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$136.06
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Devoted Health Medicare |
$149.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.06
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: AlohaCare Medicaid |
$79.22
|
| Rate for Payer: AlohaCare Medicare |
$95.52
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Devoted Health Medicare |
$105.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.38
|
| Rate for Payer: Health Management Network Commercial |
$251.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.52
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: AlohaCare Medicaid |
$8.98
|
| Rate for Payer: AlohaCare Medicare |
$12.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.95
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.60
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: AlohaCare Medicaid |
$47.89
|
| Rate for Payer: AlohaCare Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$68.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.14
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 74328 26
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$177.24 |
| Rate for Payer: AlohaCare Medicaid |
$131.53
|
| Rate for Payer: AlohaCare Medicare |
$24.87
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.24
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.87
|
|
|
CHG EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 84112
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: AlohaCare Medicaid |
$90.64
|
| Rate for Payer: AlohaCare Medicare |
$98.11
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Devoted Health Medicare |
$107.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.11
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.11
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 76818 TC
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: AlohaCare Medicaid |
$77.98
|
| Rate for Payer: AlohaCare Medicare |
$81.28
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Devoted Health Medicare |
$89.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.66
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.28
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$294.10 |
| Rate for Payer: AlohaCare Medicaid |
$77.98
|
| Rate for Payer: AlohaCare Medicare |
$132.64
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$145.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.66
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.64
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 76818 26
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$113.66 |
| Rate for Payer: AlohaCare Medicaid |
$77.98
|
| Rate for Payer: AlohaCare Medicare |
$51.37
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.66
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.37
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$95.33
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$104.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.33
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.60
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: AlohaCare Medicaid |
$56.22
|
| Rate for Payer: AlohaCare Medicare |
$57.73
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$63.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.03
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.73
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 88184
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$53.46
|
| Rate for Payer: AlohaCare Medicare |
$91.91
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Devoted Health Medicare |
$101.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.53
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.91
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 88184 TC
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$53.46
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.53
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.46
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 88185 TC
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: AlohaCare Medicaid |
$16.29
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.73
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.29
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 88185
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: AlohaCare Medicaid |
$16.29
|
| Rate for Payer: AlohaCare Medicare |
$26.20
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Devoted Health Medicare |
$28.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.73
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.20
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$28.83
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$31.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.83
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 77003 TC
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Devoted Health Medicare |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.40
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$115.24
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Devoted Health Medicare |
$126.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.24
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 77001 26
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$89.19 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$17.69
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$19.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.69
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$109.41
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Devoted Health Medicare |
$120.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.41
|
|
