|
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 HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 73502 26
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$46.62 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$43.11
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Devoted Health Medicare |
$47.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.11
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$54.11
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$59.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.11
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: AlohaCare Medicare |
$27.16
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.16
|
| 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 |
$32.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.16
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: AlohaCare Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$38.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.35
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73060 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| 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 |
$34.64
|
| 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 |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 70200 26
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 70200 TC
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| 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 |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| 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 |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$51.56
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$56.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.56
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 71111 26
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$57.07 |
| Rate for Payer: AlohaCare Medicaid |
$34.95
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.07
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 71101 26
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: AlohaCare Medicaid |
$28.11
|
| Rate for Payer: AlohaCare Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.50
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.87
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 73030 26
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: AlohaCare Medicare |
$9.24
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.24
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: AlohaCare Medicare |
$39.44
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Devoted Health Medicare |
$43.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.44
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 73030 TC
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: AlohaCare Medicaid |
$23.33
|
| Rate for Payer: AlohaCare Medicare |
$30.20
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| 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 |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| 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 |
$23.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.20
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 72040 TC
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$26.42
|
| Rate for Payer: AlohaCare Medicare |
$33.23
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| 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 |
$38.42
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| 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 |
$26.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.23
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 72040 26
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: AlohaCare Medicaid |
$26.42
|
| Rate for Payer: AlohaCare Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$11.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.42
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.63
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: AlohaCare Medicaid |
$26.42
|
| Rate for Payer: AlohaCare Medicare |
$43.86
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Devoted Health Medicare |
$48.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.42
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.86
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$35.91
|
| Rate for Payer: AlohaCare Medicare |
$60.91
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$67.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.91
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 72050 26
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: AlohaCare Medicaid |
$35.91
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 72050 TC
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicaid |
$35.91
|
| Rate for Payer: AlohaCare Medicare |
$47.66
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$52.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.66
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 72052 TC
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$41.90
|
| Rate for Payer: AlohaCare Medicare |
$54.88
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$60.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.44
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.88
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 72052 26
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$69.44 |
| Rate for Payer: AlohaCare Medicaid |
$41.90
|
| Rate for Payer: AlohaCare Medicare |
$14.63
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Devoted Health Medicare |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.44
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.63
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: AlohaCare Medicaid |
$41.90
|
| Rate for Payer: AlohaCare Medicare |
$69.51
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$76.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.44
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.51
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$59.06
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$64.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.06
|
|
