|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 72110 26
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$12.91
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.91
|
|
|
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
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AlohaCare Medicaid |
$40.98
|
| Rate for Payer: AlohaCare Medicare |
$68.37
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Devoted Health Medicare |
$75.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.81
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.37
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 72114 26
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$71.81 |
| Rate for Payer: AlohaCare Medicaid |
$40.98
|
| 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 |
$71.81
|
| 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 |
$40.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.63
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 72114 TC
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: AlohaCare Medicaid |
$40.98
|
| Rate for Payer: AlohaCare Medicare |
$53.74
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$59.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.81
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.74
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: AlohaCare Medicaid |
$21.89
|
| Rate for Payer: AlohaCare Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$39.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.31
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 72070 TC
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: AlohaCare Medicaid |
$21.89
|
| Rate for Payer: AlohaCare Medicare |
$26.40
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| 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 |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| 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 |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.40
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 72070 26
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: AlohaCare Medicaid |
$21.89
|
| Rate for Payer: AlohaCare Medicare |
$9.91
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.59
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.91
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: AlohaCare Medicaid |
$26.39
|
| Rate for Payer: AlohaCare Medicare |
$42.67
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$46.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.41
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.67
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 72072 TC
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: AlohaCare Medicaid |
$26.39
|
| Rate for Payer: AlohaCare Medicare |
$32.09
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$35.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.41
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.09
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 72072 26
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: AlohaCare Medicaid |
$26.39
|
| Rate for Payer: AlohaCare Medicare |
$10.58
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$11.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.41
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.58
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$39.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.48
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.31
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 71120 26
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$9.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.48
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.53
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$26.78
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.48
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.78
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 73110 26
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| 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 |
$27.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.91
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| Rate for Payer: AlohaCare Medicare |
$47.46
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$52.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.46
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 73110 TC
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$27.72
|
| Rate for Payer: AlohaCare Medicare |
$38.55
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$42.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.55
|
|
|
CHG RADIATION TREATMENT DELIVERY >=1 MEV COMPLEX
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 77412
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$660.45 |
| Rate for Payer: AlohaCare Medicaid |
$76.99
|
| Rate for Payer: AlohaCare Medicare |
$503.03
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Devoted Health Medicare |
$553.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$503.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.11
|
| Rate for Payer: Health Management Network Commercial |
$660.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$603.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$603.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$603.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$503.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$503.03
|
|
|
CHG RADIATION TREATMENT DELIVERY >=1 MEV SIMPLE
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 77402
|
| Min. Negotiated Rate |
$58.71 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: AlohaCare Medicaid |
$58.71
|
| Rate for Payer: AlohaCare Medicare |
$93.05
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Devoted Health Medicare |
$102.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.28
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.05
|
|
|
CHG RADIATION TX DELIVERY >=1 MEV INTERMEDIATE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 77407
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: AlohaCare Medicaid |
$68.94
|
| Rate for Payer: AlohaCare Medicare |
$351.31
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Devoted Health Medicare |
$386.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$351.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.16
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$421.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$421.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$351.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$351.31
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 75989 26
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: AlohaCare Medicaid |
$72.05
|
| Rate for Payer: AlohaCare Medicare |
$55.10
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Devoted Health Medicare |
$60.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.69
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.10
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Min. Negotiated Rate |
$65.89 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: AlohaCare Medicaid |
$72.05
|
| Rate for Payer: AlohaCare Medicare |
$65.89
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$72.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.69
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.89
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$72.05 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: AlohaCare Medicaid |
$72.05
|
| Rate for Payer: AlohaCare Medicare |
$121.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Devoted Health Medicare |
$133.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.69
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.00
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$20.11
|
| Rate for Payer: AlohaCare Medicare |
$32.60
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$35.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.60
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: AlohaCare Medicaid |
$20.11
|
| Rate for Payer: AlohaCare Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$26.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.74
|
|
