|
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 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
|
$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 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 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
|
$15.00
|
|
|
Service Code
|
HCPCS 74018 26
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: AlohaCare Medicaid |
$20.11
|
| 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 |
$32.81
|
| 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 |
$20.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
|
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
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 74021 26
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: AlohaCare Medicaid |
$28.57
|
| Rate for Payer: AlohaCare Medicare |
$12.68
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.68
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: AlohaCare Medicaid |
$28.57
|
| Rate for Payer: AlohaCare Medicare |
$33.61
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Devoted Health Medicare |
$36.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.61
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 74021
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: AlohaCare Medicaid |
$28.57
|
| Rate for Payer: AlohaCare Medicare |
$46.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Devoted Health Medicare |
$50.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.29
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 73565 26
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$30.81 |
| Rate for Payer: AlohaCare Medicaid |
$26.83
|
| Rate for Payer: AlohaCare Medicare |
$8.58
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.81
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.58
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 73565
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: AlohaCare Medicaid |
$26.83
|
| Rate for Payer: AlohaCare Medicare |
$46.75
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$51.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.81
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.75
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 73565 TC
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: AlohaCare Medicaid |
$26.83
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| 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 |
$30.81
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| 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 |
$26.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$26.02
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Devoted Health Medicare |
$28.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.25
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.02
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 71046
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$36.26
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$39.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.25
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.26
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 71046 26
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$10.25
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$11.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.25
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.25
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: AlohaCare Medicaid |
$16.90
|
| Rate for Payer: AlohaCare Medicare |
$19.18
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$21.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.57
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.18
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 71045 26
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: AlohaCare Medicaid |
$16.90
|
| Rate for Payer: AlohaCare Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.57
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 71045
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$16.90
|
| Rate for Payer: AlohaCare Medicare |
$27.67
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Devoted Health Medicare |
$30.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.57
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.67
|
|
