|
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
|
$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
|
$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
|
$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 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 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
|
$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
|
|
|
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 VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$121.43
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Devoted Health Medicare |
$133.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.43
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 75825 26
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$73.33
|
| Rate for Payer: AlohaCare Medicare |
$51.74
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$56.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.74
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$75.01
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$82.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.01
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$76.66 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$127.32
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$140.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.32
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 75827 26
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$616.76 |
| Rate for Payer: AlohaCare Medicaid |
$76.66
|
| Rate for Payer: AlohaCare Medicare |
$52.31
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$57.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$616.76
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.31
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$142.33
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Devoted Health Medicare |
$156.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$304.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.33
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Min. Negotiated Rate |
$74.63 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Devoted Health Medicare |
$82.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.63
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 75822 26
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$122.37 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$67.70
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Devoted Health Medicare |
$74.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.37
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.70
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$67.03
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| 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 |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| 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 |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.03
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 75820 26
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$80.24 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$48.53
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Devoted Health Medicare |
$53.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.53
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: AlohaCare Medicaid |
$69.94
|
| Rate for Payer: AlohaCare Medicare |
$115.56
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Devoted Health Medicare |
$127.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.24
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.56
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 75833 TC
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$636.14 |
| Rate for Payer: AlohaCare Medicaid |
$94.99
|
| Rate for Payer: AlohaCare Medicare |
$96.09
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Devoted Health Medicare |
$105.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.14
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.09
|
|
