|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 76080 26
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$75.81 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$24.17
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$26.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.17
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$43.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.31
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$41.00
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$45.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.00
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$32.47
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$35.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.47
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73610 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73070 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: AlohaCare Medicare |
$8.20
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$9.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 73070
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: AlohaCare Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.31
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: AlohaCare Medicare |
$24.12
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$26.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.12
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$27.92
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$30.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.92
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 73080 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 73080
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$36.45
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$40.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.45
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73630 26
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$22.90
|
| Rate for Payer: AlohaCare Medicare |
$8.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$8.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.15
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73630
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$22.90
|
| Rate for Payer: AlohaCare Medicare |
$37.59
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.59
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: AlohaCare Medicaid |
$22.90
|
| Rate for Payer: AlohaCare Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$32.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.44
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 76010 TC
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$22.98
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$25.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.98
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 76010 26
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76010
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$31.46
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$34.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.46
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73120
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: AlohaCare Medicare |
$34.59
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$38.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.59
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: AlohaCare Medicare |
$26.40
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Devoted Health Medicare |
$29.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.40
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73120 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: AlohaCare Medicare |
$8.20
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$9.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 73130 26
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: AlohaCare Medicare |
$8.91
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$9.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.91
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: AlohaCare Medicare |
$42.14
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$46.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.14
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: AlohaCare Medicare |
$33.23
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$36.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.23
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$38.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.13
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$46.14
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Devoted Health Medicare |
$50.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.14
|
|
