|
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 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
|
$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 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
|
$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 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 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
|
$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 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
|
|
|
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 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
|
$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
|
$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
|
|
|
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
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$20,407.42
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$20,407.42 |
| Max. Negotiated Rate |
$20,407.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,407.42
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$20,407.42
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$20,407.42 |
| Max. Negotiated Rate |
$20,407.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,407.42
|
|
|
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
|
|
