|
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
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 74455 26
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$87.58 |
| Rate for Payer: AlohaCare Medicaid |
$70.38
|
| Rate for Payer: AlohaCare Medicare |
$16.01
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$17.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.01
|
|
|
CHG URINALYSIS MICROSCOPIC ONLY
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 81015
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: UnitedHealthcare Medicare |
$3.05
|
| Rate for Payer: AlohaCare Medicaid |
$4.20
|
| Rate for Payer: AlohaCare Medicare |
$3.05
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$3.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$46.48
|
| Rate for Payer: AlohaCare Medicare |
$82.30
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Devoted Health Medicare |
$90.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.96
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.30
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 78730 TC
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: AlohaCare Medicaid |
$46.48
|
| Rate for Payer: AlohaCare Medicare |
$74.25
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$81.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.96
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.25
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 78730 26
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: AlohaCare Medicaid |
$46.48
|
| Rate for Payer: AlohaCare Medicare |
$8.05
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.96
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.05
|
|
|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: AlohaCare Medicaid |
$8.74
|
| Rate for Payer: AlohaCare Medicare |
$8.61
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.75
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.61
|
|
|
CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 81000
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: AlohaCare Medicaid |
$4.37
|
| Rate for Payer: AlohaCare Medicare |
$4.02
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.02
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: AlohaCare Medicaid |
$3.10
|
| Rate for Payer: AlohaCare Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.10
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.25
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: AlohaCare Medicaid |
$3.54
|
| Rate for Payer: AlohaCare Medicare |
$3.48
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.55
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.48
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: AlohaCare Medicaid |
$90.90
|
| Rate for Payer: AlohaCare Medicare |
$146.88
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Devoted Health Medicare |
$161.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.84
|
| Rate for Payer: Health Management Network Commercial |
$382.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.88
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 74400 TC
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: AlohaCare Medicaid |
$90.90
|
| Rate for Payer: AlohaCare Medicare |
$123.81
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Devoted Health Medicare |
$136.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.84
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.81
|
|
|
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
|
$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 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
|
$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 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 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 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 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
|
$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 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
|
$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
|
$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
|
|
