|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 95829 26
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,990.80
|
| Rate for Payer: AlohaCare Medicare |
$349.73
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Devoted Health Medicare |
$384.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.25
|
| Rate for Payer: Health Management Network Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$419.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$419.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,990.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,990.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.73
|
|
|
PR ELECTRODIAG STUDIES DSP DOCD RVWD W/IN 6 MONTHS
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 3751F
|
| Min. Negotiated Rate |
$674.90 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
|
|
PR ELECTRODIAG STUDIES DSP NOT DOCD RVWD W/IN 6 MON
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 3752F
|
| Min. Negotiated Rate |
$1,064.20 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 95812 TC
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$368.39
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Devoted Health Medicare |
$405.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$923.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$442.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.39
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$428.97
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Devoted Health Medicare |
$471.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$428.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$1,014.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$514.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$514.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$428.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$428.97
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 95812 26
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$395.24 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$60.59
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$66.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.59
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$1,148.35 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$442.64
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Devoted Health Medicare |
$486.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$1,148.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.64
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95822 26
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$466.95 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$58.82
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$64.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.82
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$1,235.90 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$501.46
|
| Rate for Payer: Cash Price |
$872.40
|
| Rate for Payer: Cash Price |
$872.40
|
| Rate for Payer: Devoted Health Medicare |
$551.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$501.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$1,235.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$501.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$501.46
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95819 26
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$514.57 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$58.82
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$64.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.82
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 95819 TC
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$1,257.15 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$482.71
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Devoted Health Medicare |
$530.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$1,257.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.71
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$1,344.70 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$541.53
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Devoted Health Medicare |
$595.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$541.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$1,344.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$649.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$649.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$649.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$541.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$541.53
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$1,141.55 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$463.48
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Devoted Health Medicare |
$509.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$463.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$1,141.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$556.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$556.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$556.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$463.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$463.48
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 95816 26
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$445.92 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$58.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Devoted Health Medicare |
$64.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.44
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 95816 TC
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$1,054.85 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$405.04
|
| Rate for Payer: Cash Price |
$744.60
|
| Rate for Payer: Cash Price |
$744.60
|
| Rate for Payer: Devoted Health Medicare |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$1,054.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$486.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.04
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$70,017.75
|
|
|
Service Code
|
MSDRG 791
|
| Min. Negotiated Rate |
$46,168.10 |
| Max. Negotiated Rate |
$70,017.75 |
| Rate for Payer: AlohaCare Medicare |
$46,168.10
|
| Rate for Payer: Devoted Health Medicare |
$50,784.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63,043.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46,168.10
|
| Rate for Payer: Humana Medicare |
$46,168.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$70,017.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$46,168.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$46,168.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$46,168.10
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$42,248.70
|
|
|
Service Code
|
MSDRG 792
|
| Min. Negotiated Rate |
$12,618.32 |
| Max. Negotiated Rate |
$42,248.70 |
| Rate for Payer: AlohaCare Medicare |
$27,857.82
|
| Rate for Payer: Devoted Health Medicare |
$30,643.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,618.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27,857.82
|
| Rate for Payer: Humana Medicare |
$27,857.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$42,248.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$27,857.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$27,857.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$27,857.82
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$518.79 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: AlohaCare Medicaid |
$562.07
|
| Rate for Payer: AlohaCare Medicare |
$518.79
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$570.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$536.38
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$622.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$622.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$562.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$562.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.79
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,381.25 |
| Rate for Payer: AlohaCare Medicaid |
$953.59
|
| Rate for Payer: AlohaCare Medicare |
$877.13
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Devoted Health Medicare |
$964.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$877.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$1,381.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,052.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,052.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$953.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$877.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$953.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$877.13
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$613.08 |
| Max. Negotiated Rate |
$1,288.60 |
| Rate for Payer: AlohaCare Medicaid |
$888.56
|
| Rate for Payer: AlohaCare Medicare |
$818.14
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Devoted Health Medicare |
$899.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$818.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$613.08
|
| Rate for Payer: Health Management Network Commercial |
$1,288.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$981.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$981.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$981.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$888.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$818.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$888.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$818.14
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,216.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$846.82 |
| Max. Negotiated Rate |
$1,883.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.80
|
| Rate for Payer: AlohaCare Medicare |
$1,195.69
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Devoted Health Medicare |
$1,315.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,195.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$846.82
|
| Rate for Payer: Health Management Network Commercial |
$1,883.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,434.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,434.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,434.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,195.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,195.69
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: AlohaCare Medicaid |
$561.31
|
| Rate for Payer: AlohaCare Medicare |
$519.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Devoted Health Medicare |
$571.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$519.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$815.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$623.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$561.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$519.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$561.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$519.54
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$293.25
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$167.57 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: AlohaCare Medicaid |
$170.83
|
| Rate for Payer: AlohaCare Medicare |
$167.57
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Devoted Health Medicare |
$184.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.10
|
| Rate for Payer: Health Management Network Commercial |
$249.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.57
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$118.90
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$67.94 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: AlohaCare Medicaid |
$69.44
|
| Rate for Payer: AlohaCare Medicare |
$67.94
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Devoted Health Medicare |
$74.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.92
|
| Rate for Payer: Health Management Network Commercial |
$101.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.94
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$18.95
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: AlohaCare Medicaid |
$11.18
|
| Rate for Payer: AlohaCare Medicare |
$10.83
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Devoted Health Medicare |
$11.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.90
|
| Rate for Payer: Health Management Network Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.83
|
|
