|
PR ENDOVAS NON-CARDIAC ABL CATH
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1888
|
| Min. Negotiated Rate |
$1,336.20 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Health Management Network Commercial |
$1,336.20
|
|
|
PR ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN
|
Professional
|
Both
|
$3,248.61
|
|
|
Service Code
|
HCPCS 36482
|
| Min. Negotiated Rate |
$150.81 |
| Max. Negotiated Rate |
$2,761.32 |
| Rate for Payer: AlohaCare Medicaid |
$169.73
|
| Rate for Payer: AlohaCare Medicare |
$150.81
|
| Rate for Payer: Cash Price |
$1,949.17
|
| Rate for Payer: Cash Price |
$1,949.17
|
| Rate for Payer: Devoted Health Medicare |
$165.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$270.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,446.08
|
| Rate for Payer: Health Management Network Commercial |
$2,761.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.81
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$2,023.88
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$235.18 |
| Max. Negotiated Rate |
$2,263.04 |
| Rate for Payer: AlohaCare Medicaid |
$262.92
|
| Rate for Payer: AlohaCare Medicare |
$235.18
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Devoted Health Medicare |
$258.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$262.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$508.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$235.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$262.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,263.04
|
| Rate for Payer: Health Management Network Commercial |
$1,720.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$282.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$282.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$235.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$262.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$235.18
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Professional
|
Both
|
$516.36
|
|
|
Service Code
|
HCPCS 36476
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$438.91 |
| Rate for Payer: AlohaCare Medicaid |
$125.06
|
| Rate for Payer: AlohaCare Medicare |
$111.25
|
| Rate for Payer: Cash Price |
$309.82
|
| Rate for Payer: Cash Price |
$309.82
|
| Rate for Payer: Devoted Health Medicare |
$122.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$220.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.70
|
| Rate for Payer: Health Management Network Commercial |
$438.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$133.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.25
|
|
|
PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 44121
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$334.90 |
| Rate for Payer: AlohaCare Medicaid |
$230.50
|
| Rate for Payer: AlohaCare Medicare |
$206.33
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Devoted Health Medicare |
$226.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$247.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.33
|
|
|
PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX
|
Professional
|
Both
|
$2,221.00
|
|
|
Service Code
|
HCPCS 44130
|
| Min. Negotiated Rate |
$619.32 |
| Max. Negotiated Rate |
$1,887.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,294.90
|
| Rate for Payer: AlohaCare Medicare |
$1,201.26
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Devoted Health Medicare |
$1,321.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,201.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$619.32
|
| Rate for Payer: Health Management Network Commercial |
$1,887.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,441.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,441.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,441.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,294.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,201.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,294.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,201.26
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 44005
|
| Min. Negotiated Rate |
$852.28 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.82
|
| Rate for Payer: AlohaCare Medicare |
$993.21
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Devoted Health Medicare |
$1,092.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$993.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$852.28
|
| Rate for Payer: Health Management Network Commercial |
$1,560.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,191.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,191.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,191.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,071.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$993.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,071.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$993.21
|
|
|
PR ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
HCPCS 44603
|
| Min. Negotiated Rate |
$680.68 |
| Max. Negotiated Rate |
$2,296.70 |
| Rate for Payer: Kaiser Permanente Medicaid |
$1,725.49
|
| Rate for Payer: AlohaCare Medicaid |
$1,579.31
|
| Rate for Payer: AlohaCare Medicare |
$1,437.91
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Devoted Health Medicare |
$1,581.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,437.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$680.68
|
| Rate for Payer: Health Management Network Commercial |
$2,296.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,725.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,725.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,579.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,437.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,579.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,437.91
|
|
|
PR ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$2,339.00
|
|
|
Service Code
|
HCPCS 44602
|
| Min. Negotiated Rate |
$539.24 |
| Max. Negotiated Rate |
$1,988.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,367.51
|
| Rate for Payer: AlohaCare Medicare |
$1,244.94
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Devoted Health Medicare |
$1,369.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,244.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$539.24
|
| Rate for Payer: Health Management Network Commercial |
$1,988.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,493.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,493.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,493.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,367.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,244.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,367.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,244.94
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 44377
|
| Min. Negotiated Rate |
$261.44 |
| Max. Negotiated Rate |
$430.10 |
| Rate for Payer: AlohaCare Medicaid |
$297.16
|
| Rate for Payer: AlohaCare Medicare |
$261.44
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Devoted Health Medicare |
$287.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$297.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.44
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 44376
|
| Min. Negotiated Rate |
$249.51 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: AlohaCare Medicaid |
$282.47
|
| Rate for Payer: AlohaCare Medicare |
$249.51
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Devoted Health Medicare |
$274.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.56
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$299.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$299.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.51
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 44378
|
| Min. Negotiated Rate |
$335.44 |
| Max. Negotiated Rate |
$552.50 |
| Rate for Payer: AlohaCare Medicaid |
$381.71
|
| Rate for Payer: AlohaCare Medicare |
$335.44
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$368.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$335.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$469.56
|
| Rate for Payer: Health Management Network Commercial |
$552.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$402.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$402.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$381.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$335.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$381.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$335.44
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 44366
|
| Min. Negotiated Rate |
$211.69 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: AlohaCare Medicaid |
$239.11
|
| Rate for Payer: AlohaCare Medicare |
$211.69
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Devoted Health Medicare |
$232.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$287.04
|
| Rate for Payer: Health Management Network Commercial |
$346.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$239.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.69
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
HCPCS 44021
|
| Min. Negotiated Rate |
$562.12 |
| Max. Negotiated Rate |
$1,396.55 |
| Rate for Payer: AlohaCare Medicaid |
$955.36
|
| Rate for Payer: AlohaCare Medicare |
$886.79
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Devoted Health Medicare |
$975.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$886.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$562.12
|
| Rate for Payer: Health Management Network Commercial |
$1,396.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,064.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,064.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,064.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$955.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$886.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$955.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$886.79
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 44020
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$1,399.10 |
| Rate for Payer: AlohaCare Medicaid |
$958.67
|
| Rate for Payer: AlohaCare Medicare |
$893.11
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Devoted Health Medicare |
$982.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.58
|
| Rate for Payer: Health Management Network Commercial |
$1,399.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,071.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$958.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$958.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.11
|
|
|
PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$703.04 |
| Max. Negotiated Rate |
$1,743.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,197.17
|
| Rate for Payer: AlohaCare Medicare |
$1,104.03
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Devoted Health Medicare |
$1,214.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$703.04
|
| Rate for Payer: Health Management Network Commercial |
$1,743.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,324.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,324.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,324.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,197.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,197.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.03
|
|
|
PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN
|
Professional
|
Both
|
$518.32
|
|
|
Service Code
|
HCPCS 93641 26
|
| Min. Negotiated Rate |
$296.18 |
| Max. Negotiated Rate |
$570.23 |
| Rate for Payer: AlohaCare Medicaid |
$547.26
|
| Rate for Payer: AlohaCare Medicare |
$296.18
|
| Rate for Payer: Cash Price |
$310.99
|
| Rate for Payer: Cash Price |
$310.99
|
| Rate for Payer: Devoted Health Medicare |
$325.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.23
|
| Rate for Payer: Health Management Network Commercial |
$440.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$547.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$547.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.18
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$603.96 |
| Max. Negotiated Rate |
$949.45 |
| Rate for Payer: AlohaCare Medicaid |
$650.02
|
| Rate for Payer: AlohaCare Medicare |
$603.96
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Devoted Health Medicare |
$664.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$603.96
|
| Rate for Payer: Health Management Network Commercial |
$949.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$724.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$724.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$724.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$603.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$650.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$603.96
|
|
|
PREP IRRISEPT ISEPT-450-USA
|
Facility
|
IP
|
$493.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.05 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
|
|
PREP IRRISEPT ISEPT-450-USA
|
Facility
|
OP
|
$493.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: AlohaCare Medicaid |
$246.50
|
| Rate for Payer: AlohaCare Medicare |
$374.68
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Devoted Health Medicare |
$414.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$374.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.35
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Humana Medicare |
$374.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$374.68
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$374.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$374.68
|
| Rate for Payer: University Health Alliance Commercial |
$359.35
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: AlohaCare Medicaid |
$375.62
|
| Rate for Payer: AlohaCare Medicare |
$330.44
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Devoted Health Medicare |
$363.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$421.98
|
| Rate for Payer: Health Management Network Commercial |
$544.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.44
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$418.90 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: AlohaCare Medicaid |
$477.37
|
| Rate for Payer: AlohaCare Medicare |
$418.90
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Devoted Health Medicare |
$460.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$418.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$528.58
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$502.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$502.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$502.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$477.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.90
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: AlohaCare Medicaid |
$429.54
|
| Rate for Payer: AlohaCare Medicare |
$376.79
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Devoted Health Medicare |
$414.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$432.12
|
| Rate for Payer: Health Management Network Commercial |
$621.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$452.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$452.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$429.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.79
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: AlohaCare Medicaid |
$320.63
|
| Rate for Payer: AlohaCare Medicare |
$281.75
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Devoted Health Medicare |
$309.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$428.22
|
| Rate for Payer: Health Management Network Commercial |
$464.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$338.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$320.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.75
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$638.82 |
| Rate for Payer: AlohaCare Medicaid |
$361.48
|
| Rate for Payer: AlohaCare Medicare |
$317.80
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Devoted Health Medicare |
$349.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$638.82
|
| Rate for Payer: Health Management Network Commercial |
$523.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$381.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$381.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$381.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$361.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$361.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.80
|
|
