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