|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,182.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$1,130.84 |
| Max. Negotiated Rate |
$1,854.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,277.79
|
| Rate for Payer: AlohaCare Medicare |
$1,130.84
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Devoted Health Medicare |
$1,243.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,240.87
|
| Rate for Payer: Health Management Network Commercial |
$1,854.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,357.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,357.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,357.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,277.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,277.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.84
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$4,363.61
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$85.02 |
| Max. Negotiated Rate |
$3,709.07 |
| Rate for Payer: AlohaCare Medicaid |
$329.53
|
| Rate for Payer: AlohaCare Medicare |
$297.67
|
| Rate for Payer: Cash Price |
$2,618.17
|
| Rate for Payer: Cash Price |
$2,618.17
|
| Rate for Payer: Devoted Health Medicare |
$327.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$329.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$283.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$329.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.02
|
| Rate for Payer: Health Management Network Commercial |
$3,709.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$329.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$329.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.67
|
| Rate for Payer: University Health Alliance Commercial |
$412.57
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Professional
|
Both
|
$2,151.80
|
|
|
Service Code
|
HCPCS 47533
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$1,829.03 |
| Rate for Payer: AlohaCare Medicaid |
$254.76
|
| Rate for Payer: AlohaCare Medicare |
$223.22
|
| Rate for Payer: Cash Price |
$1,291.08
|
| Rate for Payer: Cash Price |
$1,291.08
|
| Rate for Payer: Devoted Health Medicare |
$245.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$254.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$480.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$254.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,534.26
|
| Rate for Payer: Health Management Network Commercial |
$1,829.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.22
|
| Rate for Payer: University Health Alliance Commercial |
$343.07
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT
|
Professional
|
Both
|
$2,339.02
|
|
|
Service Code
|
HCPCS 47534
|
| Min. Negotiated Rate |
$311.21 |
| Max. Negotiated Rate |
$1,988.17 |
| Rate for Payer: AlohaCare Medicaid |
$356.10
|
| Rate for Payer: AlohaCare Medicare |
$311.21
|
| Rate for Payer: Cash Price |
$1,403.41
|
| Rate for Payer: Cash Price |
$1,403.41
|
| Rate for Payer: Devoted Health Medicare |
$342.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$356.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$635.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$356.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,886.04
|
| Rate for Payer: Health Management Network Commercial |
$1,988.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$373.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$356.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$356.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.21
|
| Rate for Payer: University Health Alliance Commercial |
$501.98
|
|
|
PR PRQ PORTAL VEIN CATHETERIZATION ANY METHOD
|
Professional
|
Both
|
$3,186.84
|
|
|
Service Code
|
HCPCS 36481
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$2,708.81 |
| Rate for Payer: AlohaCare Medicaid |
$314.34
|
| Rate for Payer: AlohaCare Medicare |
$275.77
|
| Rate for Payer: Cash Price |
$1,912.10
|
| Rate for Payer: Cash Price |
$1,912.10
|
| Rate for Payer: Devoted Health Medicare |
$303.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$314.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$531.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$314.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$341.38
|
| Rate for Payer: Health Management Network Commercial |
$2,708.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$314.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.77
|
| Rate for Payer: University Health Alliance Commercial |
$418.69
|
|
|
PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 27756
|
| Min. Negotiated Rate |
$459.16 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: AlohaCare Medicaid |
$609.93
|
| Rate for Payer: AlohaCare Medicare |
$580.07
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Devoted Health Medicare |
$638.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$459.16
|
| Rate for Payer: Health Management Network Commercial |
$906.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$696.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$696.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$696.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$609.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$609.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.07
|
|
|
PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 26650
|
| Min. Negotiated Rate |
$311.48 |
| Max. Negotiated Rate |
$762.45 |
| Rate for Payer: AlohaCare Medicaid |
$520.32
|
| Rate for Payer: AlohaCare Medicare |
$491.82
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Devoted Health Medicare |
$541.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$491.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$311.48
|
| Rate for Payer: Health Management Network Commercial |
$762.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$590.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$590.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$590.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$520.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$491.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$520.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$491.82
|
|
|
PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 28406
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$919.70 |
| Rate for Payer: AlohaCare Medicaid |
$632.17
|
| Rate for Payer: AlohaCare Medicare |
$572.88
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Devoted Health Medicare |
$630.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$572.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$919.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$687.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$687.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$687.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$572.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$632.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$572.88
|
|
|
PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 27509
|
| Min. Negotiated Rate |
$378.56 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$714.27
|
| Rate for Payer: AlohaCare Medicare |
$674.80
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$742.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$674.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.56
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$809.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$809.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$809.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$714.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$674.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$714.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$674.80
|
|
|
PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 26608
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: AlohaCare Medicaid |
$518.73
|
| Rate for Payer: AlohaCare Medicare |
$483.18
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Devoted Health Medicare |
$531.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.82
|
| Rate for Payer: Health Management Network Commercial |
$756.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$518.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$518.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.18
|
|
|
PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 26676
|
| Min. Negotiated Rate |
$328.64 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: AlohaCare Medicaid |
$550.67
|
| Rate for Payer: AlohaCare Medicare |
$510.41
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Devoted Health Medicare |
$561.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$510.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$328.64
|
| Rate for Payer: Health Management Network Commercial |
$804.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$612.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$612.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$612.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$550.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$510.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$550.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$510.41
|
|
|
PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 26756
|
| Min. Negotiated Rate |
$214.24 |
| Max. Negotiated Rate |
$672.35 |
| Rate for Payer: AlohaCare Medicaid |
$461.10
|
| Rate for Payer: AlohaCare Medicare |
$435.00
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$478.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$435.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.24
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$522.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$461.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$435.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$461.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$435.00
|
|
|
PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 27235
|
| Min. Negotiated Rate |
$778.96 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: AlohaCare Medicaid |
$932.97
|
| Rate for Payer: AlohaCare Medicare |
$843.71
|
| Rate for Payer: Cash Price |
$961.20
|
| Rate for Payer: Cash Price |
$961.20
|
| Rate for Payer: Devoted Health Medicare |
$928.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$843.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$778.96
|
| Rate for Payer: Health Management Network Commercial |
$1,361.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$932.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$843.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$932.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$843.71
|
|
|
PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$1,056.25
|
|
|
Service Code
|
HCPCS 28496
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$897.81 |
| Rate for Payer: AlohaCare Medicaid |
$300.34
|
| Rate for Payer: AlohaCare Medicare |
$298.99
|
| Rate for Payer: Cash Price |
$633.75
|
| Rate for Payer: Cash Price |
$633.75
|
| Rate for Payer: Devoted Health Medicare |
$328.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$300.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$431.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$298.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$300.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$220.48
|
| Rate for Payer: Health Management Network Commercial |
$897.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$358.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$358.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$358.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$300.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.99
|
| Rate for Payer: University Health Alliance Commercial |
$402.00
|
|
|
PR PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS 24582
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: AlohaCare Medicaid |
$862.31
|
| Rate for Payer: AlohaCare Medicare |
$805.78
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Devoted Health Medicare |
$886.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$805.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$471.90
|
| Rate for Payer: Health Management Network Commercial |
$1,259.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$966.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$966.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$862.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$805.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$862.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$805.78
|
|
|
PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 28666
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: AlohaCare Medicaid |
$185.41
|
| Rate for Payer: AlohaCare Medicare |
$170.70
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Devoted Health Medicare |
$187.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.64
|
| Rate for Payer: Health Management Network Commercial |
$266.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$185.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.70
|
|
|
PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ
|
Professional
|
Both
|
$837.00
|
|
|
Service Code
|
HCPCS 26776
|
| Min. Negotiated Rate |
$231.66 |
| Max. Negotiated Rate |
$711.45 |
| Rate for Payer: AlohaCare Medicaid |
$486.95
|
| Rate for Payer: AlohaCare Medicare |
$454.84
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Devoted Health Medicare |
$500.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$231.66
|
| Rate for Payer: Health Management Network Commercial |
$711.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$545.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$545.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$545.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.84
|
|
|
PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 26706
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$707.20 |
| Rate for Payer: AlohaCare Medicaid |
$482.70
|
| Rate for Payer: AlohaCare Medicare |
$435.18
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Devoted Health Medicare |
$478.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$435.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.04
|
| Rate for Payer: Health Management Network Commercial |
$707.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$522.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$522.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$482.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$435.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$482.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$435.18
|
|
|
PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 26727
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: AlohaCare Medicaid |
$512.12
|
| Rate for Payer: AlohaCare Medicare |
$475.98
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Devoted Health Medicare |
$523.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.58
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$512.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.98
|
|
|
PR PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 24538
|
| Min. Negotiated Rate |
$300.82 |
| Max. Negotiated Rate |
$1,209.55 |
| Rate for Payer: AlohaCare Medicaid |
$831.85
|
| Rate for Payer: AlohaCare Medicare |
$773.23
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Devoted Health Medicare |
$850.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$773.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.82
|
| Rate for Payer: Health Management Network Commercial |
$1,209.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$927.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$927.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$927.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$831.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$773.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$831.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$773.23
|
|
|
PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 28606
|
| Min. Negotiated Rate |
$400.31 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: AlohaCare Medicaid |
$416.30
|
| Rate for Payer: AlohaCare Medicare |
$400.31
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Devoted Health Medicare |
$440.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$402.74
|
| Rate for Payer: Health Management Network Commercial |
$618.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.31
|
|
|
PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
|
Professional
|
Both
|
$2,863.07
|
|
|
Service Code
|
HCPCS 37197
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$2,433.61 |
| Rate for Payer: AlohaCare Medicaid |
$285.32
|
| Rate for Payer: AlohaCare Medicare |
$254.07
|
| Rate for Payer: Cash Price |
$1,717.84
|
| Rate for Payer: Cash Price |
$1,717.84
|
| Rate for Payer: Devoted Health Medicare |
$279.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$285.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$486.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$254.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$285.32
|
| Rate for Payer: Health Management Network Commercial |
$2,433.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$304.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$304.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$254.07
|
| Rate for Payer: University Health Alliance Commercial |
$393.20
|
|
|
PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 92973
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: AlohaCare Medicaid |
$166.22
|
| Rate for Payer: AlohaCare Medicare |
$77.38
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$85.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.71
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.38
|
|
|
PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN
|
Professional
|
Both
|
$3,083.22
|
|
|
Service Code
|
HCPCS 37187
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: AlohaCare Medicaid |
$374.49
|
| Rate for Payer: AlohaCare Medicare |
$333.91
|
| Rate for Payer: Cash Price |
$1,849.93
|
| Rate for Payer: Cash Price |
$1,849.93
|
| Rate for Payer: Devoted Health Medicare |
$367.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$374.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$639.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$333.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$374.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,049.80
|
| Rate for Payer: Health Management Network Commercial |
$2,620.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$400.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$400.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$333.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$374.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$333.91
|
| Rate for Payer: University Health Alliance Commercial |
$514.02
|
|
|
PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 92924
|
| Min. Negotiated Rate |
$445.31 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: AlohaCare Medicaid |
$594.41
|
| Rate for Payer: AlohaCare Medicare |
$445.31
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Devoted Health Medicare |
$489.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$445.31
|
| Rate for Payer: Health Management Network Commercial |
$861.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$534.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$534.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$594.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$445.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$594.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$445.31
|
|
