|
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 FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76010
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$31.46
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$34.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.46
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 76010 TC
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| Rate for Payer: AlohaCare Medicare |
$22.98
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$25.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.81
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.98
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 76010 26
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: AlohaCare Medicaid |
$19.42
|
| 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 |
$32.81
|
| 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 |
$19.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: AlohaCare Medicare |
$26.40
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| 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 |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| 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 |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.40
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73120 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| 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 |
$30.36
|
| 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 |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73120
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AlohaCare Medicaid |
$21.09
|
| Rate for Payer: AlohaCare Medicare |
$34.59
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$38.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.36
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.59
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: AlohaCare Medicare |
$42.14
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$46.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.14
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 73130 26
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| 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 |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.91
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$24.96
|
| Rate for Payer: AlohaCare Medicare |
$33.23
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| 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 |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| 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 |
$24.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.23
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$38.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.13
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 73521 26
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$27.57
|
| Rate for Payer: AlohaCare Medicare |
$46.14
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Devoted Health Medicare |
$50.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.55
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.14
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 73502 26
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$46.62 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$11.01
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.01
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$54.11
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$59.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.11
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: AlohaCare Medicaid |
$31.93
|
| Rate for Payer: AlohaCare Medicare |
$43.11
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Devoted Health Medicare |
$47.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.62
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.11
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73060 26
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| 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 |
$34.64
|
| 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 |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.20
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: AlohaCare Medicare |
$27.16
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.16
|
| 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 |
$32.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.16
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: AlohaCare Medicaid |
$21.32
|
| Rate for Payer: AlohaCare Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$38.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.35
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 70200 26
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 70200 TC
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| 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 |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| 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 |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$31.98
|
| Rate for Payer: AlohaCare Medicare |
$51.56
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$56.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.56
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 71111 26
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$57.07 |
| Rate for Payer: AlohaCare Medicaid |
$34.95
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.07
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 71101 26
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: AlohaCare Medicaid |
$28.11
|
| Rate for Payer: AlohaCare Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.50
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.87
|
|
|
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
|
|
