|
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
|
$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
|
$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
|
$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 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 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
|
$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 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
|
$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 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
|
$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 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
|
|
|
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
|
$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 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 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 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 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
|
$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
|
$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
|
$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
|
|
