|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 74220
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$257.55 |
| Rate for Payer: AlohaCare Medicaid |
$64.75
|
| Rate for Payer: AlohaCare Medicare |
$103.65
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Devoted Health Medicare |
$114.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.11
|
| Rate for Payer: Health Management Network Commercial |
$257.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.65
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 74220 TC
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: AlohaCare Medicaid |
$64.75
|
| Rate for Payer: AlohaCare Medicare |
$75.39
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Devoted Health Medicare |
$82.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.11
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.39
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 74220 26
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: AlohaCare Medicaid |
$64.75
|
| Rate for Payer: AlohaCare Medicare |
$28.26
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$31.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.11
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.26
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: AlohaCare Medicaid |
$23.78
|
| Rate for Payer: AlohaCare Medicare |
$30.57
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$33.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.57
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 73552 26
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: AlohaCare Medicaid |
$23.78
|
| Rate for Payer: AlohaCare Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 73552
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: AlohaCare Medicaid |
$23.78
|
| Rate for Payer: AlohaCare Medicare |
$39.44
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| 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 |
$36.46
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| 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 |
$23.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.44
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| Rate for Payer: AlohaCare Medicare |
$29.82
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Devoted Health Medicare |
$32.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.16
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.82
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73560 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$32.16 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| 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 |
$32.16
|
| 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 |
$22.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 73560
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| Rate for Payer: AlohaCare Medicare |
$38.01
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$41.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.16
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.01
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 73562 26
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: AlohaCare Medicare |
$9.62
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.62
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 73562
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: AlohaCare Medicare |
$47.03
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$51.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.03
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 73562 TC
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: AlohaCare Medicaid |
$27.46
|
| Rate for Payer: AlohaCare Medicare |
$37.41
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$41.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$99.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.41
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 72170 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$32.05 |
| Rate for Payer: AlohaCare Medicaid |
$18.54
|
| 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 |
$32.05
|
| 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 |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72170 TC
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AlohaCare Medicaid |
$18.54
|
| Rate for Payer: AlohaCare Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$24.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.22
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: AlohaCare Medicaid |
$18.54
|
| Rate for Payer: AlohaCare Medicare |
$30.75
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$33.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.05
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.75
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 73564 26
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$11.39
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$12.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.39
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$43.49
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$47.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.49
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$131.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.70
|
| Rate for Payer: AlohaCare Medicare |
$54.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Devoted Health Medicare |
$60.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.59
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.87
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 74210
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$100.28
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Devoted Health Medicare |
$110.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.28
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$72.73
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Devoted Health Medicare |
$80.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.73
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 74210 26
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: AlohaCare Medicaid |
$62.95
|
| Rate for Payer: AlohaCare Medicare |
$27.55
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$30.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.55
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 74250 TC
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$91.72
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Devoted Health Medicare |
$100.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.72
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 74250 26
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$82.63 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$37.99
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.99
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 74250
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$317.05 |
| Rate for Payer: AlohaCare Medicaid |
$80.76
|
| Rate for Payer: AlohaCare Medicare |
$129.70
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Devoted Health Medicare |
$142.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.63
|
| Rate for Payer: Health Management Network Commercial |
$317.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.70
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 74246 26
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.31
|
| Rate for Payer: AlohaCare Medicare |
$42.51
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Devoted Health Medicare |
$46.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.48
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.51
|
|
