|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$566.14
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$481.22 |
| Rate for Payer: AlohaCare Medicaid |
$140.69
|
| Rate for Payer: AlohaCare Medicare |
$133.63
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Devoted Health Medicare |
$146.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$140.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$232.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$140.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.54
|
| Rate for Payer: Health Management Network Commercial |
$481.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.63
|
| Rate for Payer: University Health Alliance Commercial |
$183.40
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$415.84
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$155.59 |
| Max. Negotiated Rate |
$353.46 |
| Rate for Payer: AlohaCare Medicaid |
$180.40
|
| Rate for Payer: AlohaCare Medicare |
$155.59
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Devoted Health Medicare |
$171.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$293.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.58
|
| Rate for Payer: Health Management Network Commercial |
$353.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.59
|
| Rate for Payer: University Health Alliance Commercial |
$231.09
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$275.76
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: AlohaCare Medicaid |
$114.20
|
| Rate for Payer: AlohaCare Medicare |
$101.76
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Devoted Health Medicare |
$111.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$183.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.92
|
| Rate for Payer: Health Management Network Commercial |
$234.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.76
|
| Rate for Payer: University Health Alliance Commercial |
$144.21
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$272.11
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$231.29 |
| Rate for Payer: AlohaCare Medicaid |
$120.14
|
| Rate for Payer: AlohaCare Medicare |
$104.60
|
| Rate for Payer: Cash Price |
$163.27
|
| Rate for Payer: Cash Price |
$163.27
|
| Rate for Payer: Devoted Health Medicare |
$115.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$192.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$231.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.60
|
| Rate for Payer: University Health Alliance Commercial |
$150.85
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$262.80
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$223.38 |
| Rate for Payer: AlohaCare Medicaid |
$101.78
|
| Rate for Payer: AlohaCare Medicare |
$90.55
|
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Devoted Health Medicare |
$99.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$162.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$223.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.55
|
| Rate for Payer: University Health Alliance Commercial |
$127.97
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$271.13
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$230.46 |
| Rate for Payer: AlohaCare Medicaid |
$103.68
|
| Rate for Payer: AlohaCare Medicare |
$94.93
|
| Rate for Payer: Cash Price |
$162.68
|
| Rate for Payer: Cash Price |
$162.68
|
| Rate for Payer: Devoted Health Medicare |
$104.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$167.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.74
|
| Rate for Payer: Health Management Network Commercial |
$230.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.93
|
| Rate for Payer: University Health Alliance Commercial |
$131.75
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$376.81
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$320.29 |
| Rate for Payer: AlohaCare Medicaid |
$137.32
|
| Rate for Payer: AlohaCare Medicare |
$126.07
|
| Rate for Payer: Cash Price |
$226.09
|
| Rate for Payer: Cash Price |
$226.09
|
| Rate for Payer: Devoted Health Medicare |
$138.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$223.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$320.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.07
|
| Rate for Payer: University Health Alliance Commercial |
$176.39
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$486.38
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$413.42 |
| Rate for Payer: AlohaCare Medicaid |
$182.23
|
| Rate for Payer: AlohaCare Medicare |
$165.52
|
| Rate for Payer: Cash Price |
$291.83
|
| Rate for Payer: Cash Price |
$291.83
|
| Rate for Payer: Devoted Health Medicare |
$182.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$182.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network Commercial |
$413.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.52
|
| Rate for Payer: University Health Alliance Commercial |
$240.87
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.43
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$556.75 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Health Management Network Commercial |
$556.75
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.50
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.12
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 93880 26
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$212.08 |
| Rate for Payer: AlohaCare Medicaid |
$212.08
|
| Rate for Payer: AlohaCare Medicare |
$37.66
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.42
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.66
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Min. Negotiated Rate |
$165.42 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: AlohaCare Medicaid |
$212.08
|
| Rate for Payer: AlohaCare Medicare |
$171.86
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Devoted Health Medicare |
$189.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.42
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.86
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 93880
|
| Min. Negotiated Rate |
$165.42 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: AlohaCare Medicaid |
$212.08
|
| Rate for Payer: AlohaCare Medicare |
$209.52
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Devoted Health Medicare |
$230.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.42
|
| Rate for Payer: Health Management Network Commercial |
$311.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$251.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.52
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 93990
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: AlohaCare Medicaid |
$164.04
|
| Rate for Payer: AlohaCare Medicare |
$159.95
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Devoted Health Medicare |
$175.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.27
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.95
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 93990 26
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$164.04 |
| Rate for Payer: AlohaCare Medicaid |
$164.04
|
| Rate for Payer: AlohaCare Medicare |
$21.90
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Devoted Health Medicare |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.27
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.90
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: AlohaCare Medicaid |
$164.04
|
| Rate for Payer: AlohaCare Medicare |
$138.06
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Devoted Health Medicare |
$151.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.27
|
| Rate for Payer: Health Management Network Commercial |
$348.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.06
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 93925 26
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$269.64 |
| Rate for Payer: AlohaCare Medicaid |
$269.64
|
| Rate for Payer: AlohaCare Medicare |
$36.90
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$40.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.83
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.90
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 93925 TC
|
| Min. Negotiated Rate |
$142.83 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: AlohaCare Medicaid |
$269.64
|
| Rate for Payer: AlohaCare Medicare |
$227.50
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Devoted Health Medicare |
$250.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$227.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.83
|
| Rate for Payer: Health Management Network Commercial |
$338.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$227.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$227.50
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$142.83 |
| Max. Negotiated Rate |
$393.55 |
| Rate for Payer: AlohaCare Medicaid |
$269.64
|
| Rate for Payer: AlohaCare Medicare |
$264.40
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Devoted Health Medicare |
$290.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.83
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$317.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$317.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$317.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.40
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Min. Negotiated Rate |
$131.13 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: AlohaCare Medicaid |
$161.18
|
| Rate for Payer: AlohaCare Medicare |
$133.12
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Devoted Health Medicare |
$146.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.13
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.12
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 93926 26
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$161.18 |
| Rate for Payer: AlohaCare Medicaid |
$161.18
|
| Rate for Payer: AlohaCare Medicare |
$22.27
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Devoted Health Medicare |
$24.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.13
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.27
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$131.13 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$161.18
|
| Rate for Payer: AlohaCare Medicare |
$155.39
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Devoted Health Medicare |
$170.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.13
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.39
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$531.25 |
| Rate for Payer: AlohaCare Medicaid |
$209.33
|
| Rate for Payer: AlohaCare Medicare |
$204.46
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Devoted Health Medicare |
$224.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.05
|
| Rate for Payer: Health Management Network Commercial |
$531.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.46
|
|
