|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$709.24
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$71.08 |
| Max. Negotiated Rate |
$602.85 |
| Rate for Payer: AlohaCare Medicaid |
$81.56
|
| Rate for Payer: AlohaCare Medicare |
$71.08
|
| Rate for Payer: Cash Price |
$425.54
|
| Rate for Payer: Cash Price |
$425.54
|
| Rate for Payer: Devoted Health Medicare |
$78.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.92
|
| Rate for Payer: Health Management Network Commercial |
$602.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.08
|
| Rate for Payer: University Health Alliance Commercial |
$109.52
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$7,966.75
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$6,771.74 |
| Rate for Payer: AlohaCare Medicaid |
$83.86
|
| Rate for Payer: AlohaCare Medicare |
$72.68
|
| Rate for Payer: Cash Price |
$4,780.05
|
| Rate for Payer: Cash Price |
$4,780.05
|
| Rate for Payer: Devoted Health Medicare |
$79.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$134.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.04
|
| Rate for Payer: Health Management Network Commercial |
$6,771.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.68
|
| Rate for Payer: University Health Alliance Commercial |
$113.67
|
|
|
PR INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 11960
|
| Min. Negotiated Rate |
$684.84 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,073.46
|
| Rate for Payer: AlohaCare Medicare |
$990.01
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Devoted Health Medicare |
$1,089.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$990.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$684.84
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,188.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,188.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,073.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$990.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,073.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$990.01
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: AlohaCare Medicaid |
$216.75
|
| Rate for Payer: AlohaCare Medicare |
$197.12
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Devoted Health Medicare |
$216.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.38
|
| Rate for Payer: Health Management Network Commercial |
$315.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.12
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$466.29
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$396.35 |
| Rate for Payer: AlohaCare Medicaid |
$174.98
|
| Rate for Payer: AlohaCare Medicare |
$164.67
|
| Rate for Payer: Cash Price |
$279.77
|
| Rate for Payer: Cash Price |
$279.77
|
| Rate for Payer: Devoted Health Medicare |
$181.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$396.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$197.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.67
|
| Rate for Payer: University Health Alliance Commercial |
$218.80
|
|
|
PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Professional
|
Both
|
$3,697.92
|
|
|
Service Code
|
HCPCS 37191
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$3,143.23 |
| Rate for Payer: AlohaCare Medicaid |
$211.10
|
| Rate for Payer: AlohaCare Medicare |
$185.39
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Devoted Health Medicare |
$203.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$211.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$336.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$185.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.10
|
| Rate for Payer: Health Management Network Commercial |
$3,143.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$222.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$185.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$185.39
|
| Rate for Payer: University Health Alliance Commercial |
$337.00
|
|
|
PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART
|
Professional
|
Both
|
$2,641.00
|
|
|
Service Code
|
HCPCS 35585
|
| Min. Negotiated Rate |
$1,420.11 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,549.79
|
| Rate for Payer: AlohaCare Medicare |
$1,420.11
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Devoted Health Medicare |
$1,562.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,420.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,505.40
|
| Rate for Payer: Health Management Network Commercial |
$2,244.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,704.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,704.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,704.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,549.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,420.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,549.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,420.11
|
|
|
PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,286.00
|
|
|
Service Code
|
HCPCS 35583
|
| Min. Negotiated Rate |
$1,228.10 |
| Max. Negotiated Rate |
$1,943.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,340.39
|
| Rate for Payer: AlohaCare Medicare |
$1,228.10
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Devoted Health Medicare |
$1,350.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,228.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,255.54
|
| Rate for Payer: Health Management Network Commercial |
$1,943.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,473.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,473.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,473.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,340.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,228.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,340.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,228.10
|
|
|
PR IN-SITU VEIN BYP POP-TIBL PRONEAL
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 35587
|
| Min. Negotiated Rate |
$1,139.94 |
| Max. Negotiated Rate |
$1,793.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,235.75
|
| Rate for Payer: AlohaCare Medicare |
$1,139.94
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Devoted Health Medicare |
$1,253.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,139.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,180.14
|
| Rate for Payer: Health Management Network Commercial |
$1,793.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,367.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,367.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,367.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,235.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,139.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,235.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,139.94
|
|
|
PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 33216
|
| Min. Negotiated Rate |
$308.62 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: AlohaCare Medicaid |
$367.22
|
| Rate for Payer: AlohaCare Medicare |
$327.61
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Devoted Health Medicare |
$360.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$327.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.62
|
| Rate for Payer: Health Management Network Commercial |
$532.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$393.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$327.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$327.61
|
|
|
PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 33217
|
| Min. Negotiated Rate |
$322.66 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$364.31
|
| Rate for Payer: AlohaCare Medicare |
$326.61
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$359.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.66
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$391.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.61
|
|
|
PR INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 36800
|
| Min. Negotiated Rate |
$106.41 |
| Max. Negotiated Rate |
$177.32 |
| Rate for Payer: AlohaCare Medicaid |
$118.43
|
| Rate for Payer: AlohaCare Medicare |
$106.41
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$117.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.32
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.41
|
| Rate for Payer: University Health Alliance Commercial |
$153.00
|
|
|
PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 33224
|
| Min. Negotiated Rate |
$422.97 |
| Max. Negotiated Rate |
$709.75 |
| Rate for Payer: AlohaCare Medicaid |
$488.37
|
| Rate for Payer: AlohaCare Medicare |
$422.97
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Devoted Health Medicare |
$465.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$422.97
|
| Rate for Payer: Health Management Network Commercial |
$709.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$507.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$488.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$422.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$488.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$422.97
|
|
|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
Both
|
$749.00
|
|
|
Service Code
|
HCPCS 33225
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: AlohaCare Medicaid |
$438.41
|
| Rate for Payer: AlohaCare Medicare |
$375.75
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Devoted Health Medicare |
$413.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$375.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.66
|
| Rate for Payer: Health Management Network Commercial |
$636.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$450.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$450.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$438.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$375.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$438.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$375.75
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 33240
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: AlohaCare Medicaid |
$361.33
|
| Rate for Payer: AlohaCare Medicare |
$313.32
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Devoted Health Medicare |
$344.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.52
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$361.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$361.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.32
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 33230
|
| Min. Negotiated Rate |
$325.26 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$365.12
|
| Rate for Payer: AlohaCare Medicare |
$325.26
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$357.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$325.26
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$325.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$365.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$325.26
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 33231
|
| Min. Negotiated Rate |
$348.39 |
| Max. Negotiated Rate |
$570.35 |
| Rate for Payer: AlohaCare Medicaid |
$393.41
|
| Rate for Payer: AlohaCare Medicare |
$348.39
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Devoted Health Medicare |
$383.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$348.39
|
| Rate for Payer: Health Management Network Commercial |
$570.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$418.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$418.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$348.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$393.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$348.39
|
|
|
PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 53445
|
| Min. Negotiated Rate |
$695.44 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: AlohaCare Medicaid |
$771.09
|
| Rate for Payer: AlohaCare Medicare |
$695.44
|
| Rate for Payer: Cash Price |
$793.20
|
| Rate for Payer: Cash Price |
$793.20
|
| Rate for Payer: Devoted Health Medicare |
$764.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$695.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.92
|
| Rate for Payer: Health Management Network Commercial |
$1,123.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$834.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$834.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$834.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$771.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$695.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$771.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$695.44
|
|
|
PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 33970
|
| Min. Negotiated Rate |
$298.04 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: AlohaCare Medicaid |
$331.34
|
| Rate for Payer: AlohaCare Medicare |
$298.04
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Devoted Health Medicare |
$327.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$298.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$561.86
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.04
|
|
|
PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID
|
Professional
|
Both
|
$1,825.56
|
|
|
Service Code
|
HCPCS 49418
|
| Min. Negotiated Rate |
$172.76 |
| Max. Negotiated Rate |
$1,701.18 |
| Rate for Payer: AlohaCare Medicaid |
$195.69
|
| Rate for Payer: AlohaCare Medicare |
$172.76
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Devoted Health Medicare |
$190.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,701.18
|
| Rate for Payer: Health Management Network Commercial |
$1,551.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.76
|
| Rate for Payer: University Health Alliance Commercial |
$262.50
|
|
|
PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 54405
|
| Min. Negotiated Rate |
$729.94 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: AlohaCare Medicaid |
$816.06
|
| Rate for Payer: AlohaCare Medicare |
$729.94
|
| Rate for Payer: Cash Price |
$839.40
|
| Rate for Payer: Cash Price |
$839.40
|
| Rate for Payer: Devoted Health Medicare |
$802.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$808.86
|
| Rate for Payer: Health Management Network Commercial |
$1,189.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$875.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$875.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$875.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$816.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$816.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.94
|
|
|
PR INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$84.18
|
|
|
Service Code
|
HCPCS 51701
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: AlohaCare Medicaid |
$25.22
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$50.51
|
| Rate for Payer: Cash Price |
$50.51
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$40.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.86
|
| Rate for Payer: Health Management Network Commercial |
$71.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$30.89
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
Both
|
$405.07
|
|
|
Service Code
|
HCPCS 36555
|
| Min. Negotiated Rate |
$78.42 |
| Max. Negotiated Rate |
$344.31 |
| Rate for Payer: AlohaCare Medicaid |
$82.15
|
| Rate for Payer: AlohaCare Medicare |
$78.42
|
| Rate for Payer: Cash Price |
$243.04
|
| Rate for Payer: Cash Price |
$243.04
|
| Rate for Payer: Devoted Health Medicare |
$86.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$168.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.96
|
| Rate for Payer: Health Management Network Commercial |
$344.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.42
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>
|
Professional
|
Both
|
$451.99
|
|
|
Service Code
|
HCPCS 36556
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$384.19 |
| Rate for Payer: AlohaCare Medicaid |
$82.05
|
| Rate for Payer: AlohaCare Medicare |
$75.99
|
| Rate for Payer: Cash Price |
$271.19
|
| Rate for Payer: Cash Price |
$271.19
|
| Rate for Payer: Devoted Health Medicare |
$83.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.46
|
| Rate for Payer: Health Management Network Commercial |
$384.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.99
|
|
|
PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 54400
|
| Min. Negotiated Rate |
$489.08 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: AlohaCare Medicaid |
$542.83
|
| Rate for Payer: AlohaCare Medicare |
$489.08
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Devoted Health Medicare |
$537.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$489.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$544.70
|
| Rate for Payer: Health Management Network Commercial |
$790.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$586.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$586.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$586.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$542.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$489.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$542.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$489.08
|
|
