|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: AlohaCare Medicaid |
$18.54
|
| Rate for Payer: AlohaCare Medicare |
$30.75
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$33.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.75
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72170 TC
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AlohaCare Medicaid |
$18.54
|
| Rate for Payer: AlohaCare Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$24.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.22
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 73564 26
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$11.39
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.39
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$131.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$54.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Devoted Health Medicare |
$60.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.87
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$43.49
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$47.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.49
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 74210
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$100.28
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Devoted Health Medicare |
$110.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.28
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 74210 26
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$27.55
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.55
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$72.73
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Devoted Health Medicare |
$80.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.73
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 74250 TC
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$91.72
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Devoted Health Medicare |
$100.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.72
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 74250
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$317.05 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$129.70
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Devoted Health Medicare |
$142.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$317.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.70
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 74250 26
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$82.63 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$37.99
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.99
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 74246 26
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$42.51
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Devoted Health Medicare |
$46.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.51
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 74246
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$147.90
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Devoted Health Medicare |
$162.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.90
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$105.39
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Devoted Health Medicare |
$115.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.39
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 74240
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$134.11
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Devoted Health Medicare |
$147.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.11
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 74240 TC
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$95.52
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| 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 |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.52
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 74240 26
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$102.44 |
| Rate for Payer: AlohaCare Medicaid |
$81.48
|
| Rate for Payer: AlohaCare Medicare |
$38.60
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$42.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.60
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 74248
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$86.34
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$94.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.34
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 74248 26
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$91.74 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$32.60
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$35.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.60
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 74248 TC
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$91.74 |
| Rate for Payer: AlohaCare Medicaid |
$54.01
|
| Rate for Payer: AlohaCare Medicare |
$53.74
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| 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 |
$91.74
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| 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 |
$54.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.74
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$152.12
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$167.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.12
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.12
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 79101 26
|
| Min. Negotiated Rate |
$92.11 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$92.11
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$101.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.11
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.11
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Min. Negotiated Rate |
$60.01 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: AlohaCare Medicaid |
$93.17
|
| Rate for Payer: AlohaCare Medicare |
$60.01
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$66.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.01
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.01
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicare |
$12.35
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$13.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.35
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.35
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.82
|
|
