|
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 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 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
|
$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 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 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 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 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 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 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
|
$146.00
|
|
|
Service Code
|
HCPCS 72110 TC
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$46.15
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Devoted Health Medicare |
$50.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.15
|
|
|
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
|
$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 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
|
$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 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 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 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
|
|
