|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 88313 26
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$56.19 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$11.67
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.67
|
|
|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 88313
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$90.48
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Devoted Health Medicare |
$99.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.48
|
|
|
CHG SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 88313 TC
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: AlohaCare Medicaid |
$56.19
|
| Rate for Payer: AlohaCare Medicare |
$78.81
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Devoted Health Medicare |
$86.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.81
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 88312 TC
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$95.71
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Devoted Health Medicare |
$105.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.71
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 88312 26
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$77.75 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$25.87
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.87
|
|
|
CHG SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 88312
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: AlohaCare Medicaid |
$75.72
|
| Rate for Payer: AlohaCare Medicare |
$121.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Devoted Health Medicare |
$133.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.75
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.58
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 74283 TC
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$201.47
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Devoted Health Medicare |
$221.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$308.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$241.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$241.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.47
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 74283 26
|
| Min. Negotiated Rate |
$105.72 |
| Max. Negotiated Rate |
$222.60 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$105.72
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$116.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.72
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: AlohaCare Medicaid |
$168.02
|
| Rate for Payer: AlohaCare Medicare |
$307.19
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Devoted Health Medicare |
$337.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network Commercial |
$457.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.19
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$304.62
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$258.93 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$172.93
|
| Rate for Payer: Cash Price |
$182.77
|
| Rate for Payer: Cash Price |
$182.77
|
| Rate for Payer: Devoted Health Medicare |
$190.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.15
|
| Rate for Payer: Health Management Network Commercial |
$258.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.93
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$193.81
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$164.74 |
| Rate for Payer: AlohaCare Medicaid |
$66.64
|
| Rate for Payer: AlohaCare Medicare |
$110.75
|
| Rate for Payer: Cash Price |
$116.29
|
| Rate for Payer: Cash Price |
$116.29
|
| Rate for Payer: Devoted Health Medicare |
$121.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network Commercial |
$164.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.75
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
|
|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 75970 26
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$554.51 |
| Rate for Payer: AlohaCare Medicaid |
$413.98
|
| Rate for Payer: AlohaCare Medicare |
$36.95
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$40.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.51
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$413.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.95
|
|
|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
Both
|
$4,373.00
|
|
|
Service Code
|
HCPCS 75970
|
| Min. Negotiated Rate |
$413.98 |
| Max. Negotiated Rate |
$3,717.05 |
| Rate for Payer: AlohaCare Medicaid |
$413.98
|
| Rate for Payer: Cash Price |
$2,623.80
|
| Rate for Payer: Cash Price |
$2,623.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.51
|
| Rate for Payer: Health Management Network Commercial |
$3,717.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$413.98
|
|
|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
Both
|
$4,309.00
|
|
|
Service Code
|
HCPCS 75970 TC
|
| Min. Negotiated Rate |
$413.98 |
| Max. Negotiated Rate |
$3,662.65 |
| Rate for Payer: AlohaCare Medicaid |
$413.98
|
| Rate for Payer: Cash Price |
$2,585.40
|
| Rate for Payer: Cash Price |
$2,585.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.51
|
| Rate for Payer: Health Management Network Commercial |
$3,662.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$413.98
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
Both
|
$84.02
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$71.42 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Cash Price |
$50.41
|
| Rate for Payer: Health Management Network Commercial |
$71.42
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 76496 TC
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Health Management Network Commercial |
$304.30
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 76496 26
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 76496
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Health Management Network Commercial |
$346.80
|
|
|
CHG UNLISTED PX THER RADIOLOGY CLINICAL TX PLANNING
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 77299
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
|
|
CHG UNLISTED US PROCEDURE
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76999
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 74450 26
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$82.41 |
| Rate for Payer: AlohaCare Medicaid |
$61.21
|
| Rate for Payer: AlohaCare Medicare |
$15.63
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$17.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.41
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.63
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: AlohaCare Medicaid |
$61.21
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.41
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.21
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 74450
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: AlohaCare Medicaid |
$61.21
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.41
|
| Rate for Payer: Health Management Network Commercial |
$840.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.21
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: AlohaCare Medicaid |
$70.38
|
| Rate for Payer: AlohaCare Medicare |
$117.98
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Devoted Health Medicare |
$129.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.98
|
|
