|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 72265 26
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$224.92 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$40.93
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$45.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.92
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.93
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$291.63 |
| Max. Negotiated Rate |
$1,214.65 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$476.83
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Cash Price |
$857.40
|
| Rate for Payer: Devoted Health Medicare |
$524.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$1,214.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$572.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$572.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.83
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 78452 26
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$430.36 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$76.34
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$83.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.34
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Min. Negotiated Rate |
$291.63 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$291.63
|
| Rate for Payer: AlohaCare Medicare |
$400.49
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$440.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.36
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.49
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 78451 26
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$64.67
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Devoted Health Medicare |
$71.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.67
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$771.80 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$281.24
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Devoted Health Medicare |
$309.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$771.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$337.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.24
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$1,021.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: AlohaCare Medicaid |
$210.20
|
| Rate for Payer: AlohaCare Medicare |
$345.90
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Devoted Health Medicare |
$380.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$345.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.30
|
| Rate for Payer: Health Management Network Commercial |
$867.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$415.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$415.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$345.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$345.90
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: AlohaCare Medicaid |
$5.43
|
| Rate for Payer: AlohaCare Medicare |
$4.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$4.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.29
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$81.28
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Devoted Health Medicare |
$89.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.28
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 75885
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$144.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Devoted Health Medicare |
$159.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$325.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.98
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 75885 26
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$633.16 |
| Rate for Payer: AlohaCare Medicaid |
$88.16
|
| Rate for Payer: AlohaCare Medicare |
$63.70
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$70.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.16
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.70
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 76080
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$63.48
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$69.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.48
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$43.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.31
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 76080 26
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$75.81 |
| Rate for Payer: AlohaCare Medicaid |
$38.88
|
| Rate for Payer: AlohaCare Medicare |
$24.17
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$26.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.81
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.17
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$32.47
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$35.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.47
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73610 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| 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 |
$32.77
|
| 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 |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$41.00
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$45.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.00
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73070 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| 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 |
$31.36
|
| 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 |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: AlohaCare Medicare |
$24.12
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$26.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.12
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 73070
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: AlohaCare Medicaid |
$19.48
|
| Rate for Payer: AlohaCare Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.36
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.31
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 73080
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$36.45
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$40.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.45
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 73080 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| 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 |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.98
|
| Rate for Payer: AlohaCare Medicare |
$27.92
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$30.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.92
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 73630
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$22.90
|
| Rate for Payer: AlohaCare Medicare |
$37.59
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.59
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: AlohaCare Medicaid |
$22.90
|
| Rate for Payer: AlohaCare Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$32.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.44
|
|
