|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: AlohaCare Medicaid |
$75.65
|
| Rate for Payer: AlohaCare Medicare |
$124.83
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Devoted Health Medicare |
$137.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.93
|
| Rate for Payer: Health Management Network Commercial |
$266.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.83
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$104.35 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$37.03
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$40.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.03
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 76942 26
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$104.35 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$32.16
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$35.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.16
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$69.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Devoted Health Medicare |
$76.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.20
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 76886
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: AlohaCare Medicaid |
$66.30
|
| Rate for Payer: AlohaCare Medicare |
$106.84
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$117.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.84
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.84
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 76886 26
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: AlohaCare Medicaid |
$66.30
|
| Rate for Payer: AlohaCare Medicare |
$29.17
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$32.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.17
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.17
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 76886 TC
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: AlohaCare Medicaid |
$66.30
|
| Rate for Payer: AlohaCare Medicare |
$77.67
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Devoted Health Medicare |
$85.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.67
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.67
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 76882 TC
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: AlohaCare Medicare |
$36.27
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Devoted Health Medicare |
$39.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.27
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76882 26
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: AlohaCare Medicare |
$32.65
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$35.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.65
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76882 LT
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.96
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76882 RT
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.96
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 76857
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: AlohaCare Medicaid |
$32.12
|
| Rate for Payer: AlohaCare Medicare |
$55.12
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$60.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.85
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.12
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 76857 26
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$66.85 |
| Rate for Payer: AlohaCare Medicaid |
$32.12
|
| Rate for Payer: AlohaCare Medicare |
$24.16
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$26.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.85
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.16
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: AlohaCare Medicaid |
$32.12
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.85
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.95
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 76856
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$69.99
|
| Rate for Payer: AlohaCare Medicare |
$115.63
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Devoted Health Medicare |
$127.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.63
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 76856 TC
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: AlohaCare Medicaid |
$69.99
|
| Rate for Payer: AlohaCare Medicare |
$82.60
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Devoted Health Medicare |
$90.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.60
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 76856 26
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: AlohaCare Medicaid |
$69.99
|
| Rate for Payer: AlohaCare Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$36.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.03
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 76801 26
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$102.63 |
| Rate for Payer: AlohaCare Medicaid |
$77.25
|
| Rate for Payer: AlohaCare Medicare |
$47.42
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$52.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.63
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.42
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 76801 TC
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: AlohaCare Medicaid |
$77.25
|
| Rate for Payer: AlohaCare Medicare |
$79.94
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$87.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.63
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.94
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$222.88
|
|
|
Service Code
|
HCPCS 76801
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$189.45 |
| Rate for Payer: AlohaCare Medicaid |
$77.25
|
| Rate for Payer: AlohaCare Medicare |
$127.36
|
| Rate for Payer: Cash Price |
$133.73
|
| Rate for Payer: Cash Price |
$133.73
|
| Rate for Payer: Devoted Health Medicare |
$140.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.63
|
| Rate for Payer: Health Management Network Commercial |
$189.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.36
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$57.54
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$63.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.54
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 76815
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$88.85
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Devoted Health Medicare |
$97.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.85
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76815 26
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: AlohaCare Medicaid |
$53.36
|
| Rate for Payer: AlohaCare Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$34.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.47
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.31
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 76805 TC
|
| Min. Negotiated Rate |
$89.75 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: AlohaCare Medicaid |
$89.75
|
| Rate for Payer: AlohaCare Medicare |
$100.65
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Devoted Health Medicare |
$110.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.63
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.65
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 76805 26
|
| Min. Negotiated Rate |
$48.18 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: AlohaCare Medicaid |
$89.75
|
| Rate for Payer: AlohaCare Medicare |
$48.18
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$53.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.63
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.18
|
|
