|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 74400 26
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: AlohaCare Medicaid |
$90.90
|
| Rate for Payer: AlohaCare Medicare |
$23.07
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Devoted Health Medicare |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.84
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.07
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 74420 TC
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: AlohaCare Medicaid |
$51.80
|
| Rate for Payer: AlohaCare Medicare |
$63.99
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Devoted Health Medicare |
$70.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.27
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.99
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 74420 26
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$135.27 |
| Rate for Payer: AlohaCare Medicaid |
$51.80
|
| Rate for Payer: AlohaCare Medicare |
$25.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.27
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.40
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: AlohaCare Medicaid |
$51.80
|
| Rate for Payer: AlohaCare Medicare |
$89.39
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$98.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.27
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.39
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 76706 26
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$106.39 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$26.03
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$28.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.39
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.03
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$90.96
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Devoted Health Medicare |
$100.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.39
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.96
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$116.98
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Devoted Health Medicare |
$128.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.39
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.98
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: AlohaCare Medicaid |
$76.97
|
| Rate for Payer: AlohaCare Medicare |
$125.15
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Devoted Health Medicare |
$137.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.90
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.15
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 76700 TC
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: AlohaCare Medicaid |
$76.97
|
| Rate for Payer: AlohaCare Medicare |
$86.97
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Devoted Health Medicare |
$95.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.90
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.97
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 76700 26
|
| Min. Negotiated Rate |
$38.17 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: AlohaCare Medicaid |
$76.97
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.90
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 76705 26
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$94.64 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.93
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$66.65
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$73.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$187.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.65
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$94.58
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Devoted Health Medicare |
$104.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.58
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 76641
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: AlohaCare Medicaid |
$67.92
|
| Rate for Payer: AlohaCare Medicare |
$109.75
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Devoted Health Medicare |
$120.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.81
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.75
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 76641 TC
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$121.81 |
| Rate for Payer: AlohaCare Medicaid |
$67.92
|
| Rate for Payer: AlohaCare Medicare |
$75.39
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$82.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.81
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.39
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 76641 26
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$121.81 |
| Rate for Payer: AlohaCare Medicaid |
$67.92
|
| Rate for Payer: AlohaCare Medicare |
$34.36
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.81
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.36
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 76604 26
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$87.58 |
| Rate for Payer: AlohaCare Medicaid |
$37.02
|
| Rate for Payer: AlohaCare Medicare |
$28.12
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$30.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.12
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: AlohaCare Medicaid |
$37.02
|
| Rate for Payer: AlohaCare Medicare |
$37.79
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$41.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.79
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 76604
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$138.55 |
| Rate for Payer: AlohaCare Medicaid |
$37.02
|
| Rate for Payer: AlohaCare Medicare |
$65.91
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Devoted Health Medicare |
$72.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.91
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 76881 RT
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: AlohaCare Medicaid |
$33.68
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.15
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.68
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: AlohaCare Medicaid |
$33.68
|
| Rate for Payer: AlohaCare Medicare |
$12.35
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| 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 |
$133.15
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| 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 |
$33.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.35
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 76881 26
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: AlohaCare Medicaid |
$33.68
|
| Rate for Payer: AlohaCare Medicare |
$43.84
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Devoted Health Medicare |
$48.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.15
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.84
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 76881 LT
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: AlohaCare Medicaid |
$33.68
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.15
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.68
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 76813 TC
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: AlohaCare Medicaid |
$75.65
|
| Rate for Payer: AlohaCare Medicare |
$67.03
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Devoted Health Medicare |
$73.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.93
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.03
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 76813 26
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$132.93 |
| Rate for Payer: AlohaCare Medicaid |
$75.65
|
| Rate for Payer: AlohaCare Medicare |
$57.80
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$63.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.93
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.80
|
|
