|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$89.75 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AlohaCare Medicaid |
$89.75
|
| Rate for Payer: AlohaCare Medicare |
$148.82
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Devoted Health Medicare |
$163.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.63
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.82
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Min. Negotiated Rate |
$61.09 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: AlohaCare Medicaid |
$61.09
|
| Rate for Payer: AlohaCare Medicare |
$65.13
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Devoted Health Medicare |
$71.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.13
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$61.09 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: AlohaCare Medicaid |
$61.09
|
| Rate for Payer: AlohaCare Medicare |
$101.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$111.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.30
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 76817 26
|
| Min. Negotiated Rate |
$36.17 |
| Max. Negotiated Rate |
$97.48 |
| Rate for Payer: AlohaCare Medicaid |
$61.09
|
| Rate for Payer: AlohaCare Medicare |
$36.17
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$39.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.17
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: AlohaCare Medicaid |
$71.79
|
| Rate for Payer: AlohaCare Medicare |
$81.84
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Devoted Health Medicare |
$90.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.33
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.84
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$283.05 |
| Rate for Payer: AlohaCare Medicaid |
$71.79
|
| Rate for Payer: AlohaCare Medicare |
$116.54
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Devoted Health Medicare |
$128.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.33
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.54
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 76770 26
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$127.33 |
| Rate for Payer: AlohaCare Medicaid |
$71.79
|
| Rate for Payer: AlohaCare Medicare |
$34.70
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$38.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.33
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.70
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 76775 26
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$27.59
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.29
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.59
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Min. Negotiated Rate |
$38.17 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| 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 |
$94.29
|
| 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 |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$115.08
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$97.82 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$65.76
|
| Rate for Payer: Cash Price |
$69.05
|
| Rate for Payer: Cash Price |
$69.05
|
| Rate for Payer: Devoted Health Medicare |
$72.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.29
|
| Rate for Payer: Health Management Network Commercial |
$97.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.76
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 76870 26
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$101.84 |
| Rate for Payer: AlohaCare Medicaid |
$66.47
|
| Rate for Payer: AlohaCare Medicare |
$30.22
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Devoted Health Medicare |
$33.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.84
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.22
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AlohaCare Medicaid |
$66.47
|
| Rate for Payer: AlohaCare Medicare |
$78.05
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Devoted Health Medicare |
$85.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.84
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.05
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: AlohaCare Medicaid |
$66.47
|
| Rate for Payer: AlohaCare Medicare |
$108.26
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$119.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.84
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.26
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: AlohaCare Medicaid |
$73.82
|
| Rate for Payer: AlohaCare Medicare |
$120.16
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Devoted Health Medicare |
$132.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.29
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.16
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: AlohaCare Medicaid |
$73.82
|
| Rate for Payer: AlohaCare Medicare |
$93.24
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Devoted Health Medicare |
$102.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.29
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.24
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 76536 26
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$93.29 |
| Rate for Payer: AlohaCare Medicaid |
$73.82
|
| Rate for Payer: AlohaCare Medicare |
$26.93
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$29.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.29
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.93
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 76872 TC
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: AlohaCare Medicaid |
$136.09
|
| Rate for Payer: AlohaCare Medicare |
$100.27
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Devoted Health Medicare |
$110.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.45
|
| Rate for Payer: Health Management Network Commercial |
$523.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.27
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: AlohaCare Medicaid |
$136.09
|
| Rate for Payer: AlohaCare Medicare |
$133.00
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Devoted Health Medicare |
$146.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.45
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.00
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 76872 26
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$136.09 |
| Rate for Payer: AlohaCare Medicaid |
$136.09
|
| Rate for Payer: AlohaCare Medicare |
$32.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$36.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.45
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.73
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: AlohaCare Medicaid |
$79.51
|
| Rate for Payer: AlohaCare Medicare |
$129.49
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Devoted Health Medicare |
$142.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.49
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 76830 26
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: AlohaCare Medicaid |
$79.51
|
| 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 |
$79.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.03
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: AlohaCare Medicaid |
$79.51
|
| Rate for Payer: AlohaCare Medicare |
$96.47
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Devoted Health Medicare |
$106.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.47
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Min. Negotiated Rate |
$25.03 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: AlohaCare Medicaid |
$25.03
|
| Rate for Payer: AlohaCare Medicare |
$30.20
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$33.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.50
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.20
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 76937 26
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: AlohaCare Medicaid |
$25.03
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.50
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$25.03 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: AlohaCare Medicaid |
$25.03
|
| Rate for Payer: AlohaCare Medicare |
$43.88
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Devoted Health Medicare |
$48.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.50
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.88
|
|
