|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: AlohaCare Medicaid |
$209.33
|
| Rate for Payer: AlohaCare Medicare |
$172.24
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Devoted Health Medicare |
$189.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.05
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.24
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 93970 26
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$209.33 |
| Rate for Payer: AlohaCare Medicaid |
$209.33
|
| Rate for Payer: AlohaCare Medicare |
$32.23
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$35.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.05
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.23
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: AlohaCare Medicare |
$129.21
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Devoted Health Medicare |
$142.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.82
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.21
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93971 LT
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.82
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$133.33 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: AlohaCare Medicare |
$20.59
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$22.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.82
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.59
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93971 RT
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.82
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: AlohaCare Medicare |
$108.62
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Devoted Health Medicare |
$119.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.82
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.62
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$25,335.08
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$16,705.38 |
| Max. Negotiated Rate |
$25,335.08 |
| Rate for Payer: AlohaCare Medicare |
$16,705.38
|
| Rate for Payer: Devoted Health Medicare |
$18,375.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,893.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16,705.38
|
| Rate for Payer: Humana Medicare |
$16,705.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$25,335.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$16,705.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$16,705.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$16,705.38
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$20,893.03
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$9,831.90 |
| Max. Negotiated Rate |
$20,893.03 |
| Rate for Payer: AlohaCare Medicare |
$9,831.90
|
| Rate for Payer: Devoted Health Medicare |
$10,815.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,893.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,831.90
|
| Rate for Payer: Humana Medicare |
$9,831.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,910.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,831.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,831.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,831.90
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$14.93
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: AlohaCare Medicaid |
$8.14
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| 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 |
$11.56
|
| Rate for Payer: Health Management Network Commercial |
$12.69
|
| 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 |
$8.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$7.07
|
| Rate for Payer: AlohaCare Medicare |
$7.79
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$8.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.01
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.79
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$15.21
|
| Rate for Payer: AlohaCare Medicare |
$16.32
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Devoted Health Medicare |
$17.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.55
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.32
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$110.78 |
| Rate for Payer: AlohaCare Medicaid |
$10.94
|
| Rate for Payer: AlohaCare Medicare |
$10.26
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.78
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.26
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$191.26 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: AlohaCare Medicaid |
$222.10
|
| Rate for Payer: AlohaCare Medicare |
$191.26
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Devoted Health Medicare |
$210.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.36
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$222.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$222.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.26
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$222.30
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$242.18 |
| Rate for Payer: AlohaCare Medicaid |
$242.18
|
| Rate for Payer: Cash Price |
$133.38
|
| Rate for Payer: Cash Price |
$133.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.78
|
| Rate for Payer: Health Management Network Commercial |
$188.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.18
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$42.16
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: AlohaCare Medicaid |
$25.11
|
| Rate for Payer: AlohaCare Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Devoted Health Medicare |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.62
|
| Rate for Payer: Health Management Network Commercial |
$35.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.09
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$153.86
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$199.34 |
| Rate for Payer: AlohaCare Medicaid |
$199.34
|
| Rate for Payer: Cash Price |
$92.32
|
| Rate for Payer: Cash Price |
$92.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.65
|
| Rate for Payer: Health Management Network Commercial |
$130.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.34
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$181.32
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$154.12 |
| Max. Negotiated Rate |
$154.12 |
| Rate for Payer: Cash Price |
$108.79
|
| Rate for Payer: Health Management Network Commercial |
$154.12
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 93314 26
|
| Min. Negotiated Rate |
$89.61 |
| Max. Negotiated Rate |
$246.04 |
| Rate for Payer: AlohaCare Medicaid |
$246.04
|
| Rate for Payer: AlohaCare Medicare |
$89.61
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Devoted Health Medicare |
$98.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.15
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$246.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$246.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.61
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 93314
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: AlohaCare Medicaid |
$246.04
|
| Rate for Payer: AlohaCare Medicare |
$251.59
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Devoted Health Medicare |
$276.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.15
|
| Rate for Payer: Health Management Network Commercial |
$555.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$246.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$246.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.59
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 93314 TC
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$422.45 |
| Rate for Payer: AlohaCare Medicaid |
$246.04
|
| Rate for Payer: AlohaCare Medicare |
$161.98
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Devoted Health Medicare |
$178.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.15
|
| Rate for Payer: Health Management Network Commercial |
$422.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$246.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$246.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.98
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Min. Negotiated Rate |
$152.11 |
| Max. Negotiated Rate |
$401.20 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$152.11
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Devoted Health Medicare |
$167.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$401.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.11
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 93312 26
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$288.56 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$108.07
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Devoted Health Medicare |
$118.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.07
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$256.47 |
| Max. Negotiated Rate |
$561.85 |
| Rate for Payer: AlohaCare Medicaid |
$256.47
|
| Rate for Payer: AlohaCare Medicare |
$260.18
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$286.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.56
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$312.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.18
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$291.55 |
| Rate for Payer: AlohaCare Medicaid |
$150.89
|
| Rate for Payer: AlohaCare Medicare |
$107.48
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Devoted Health Medicare |
$118.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.77
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.48
|
|
