|
PR INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS 54401
|
| Min. Negotiated Rate |
$626.86 |
| Max. Negotiated Rate |
$1,003.85 |
| Rate for Payer: AlohaCare Medicaid |
$688.69
|
| Rate for Payer: AlohaCare Medicare |
$631.19
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Devoted Health Medicare |
$694.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$631.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.86
|
| Rate for Payer: Health Management Network Commercial |
$1,003.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$757.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$757.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$631.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$688.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$631.19
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 33990
|
| Min. Negotiated Rate |
$297.22 |
| Max. Negotiated Rate |
$492.15 |
| Rate for Payer: AlohaCare Medicaid |
$339.89
|
| Rate for Payer: AlohaCare Medicare |
$297.22
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Devoted Health Medicare |
$326.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.22
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.22
|
|
|
PR INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 33995
|
| Min. Negotiated Rate |
$297.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AlohaCare Medicaid |
$334.76
|
| Rate for Payer: AlohaCare Medicare |
$297.40
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$327.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.40
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$334.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$334.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.40
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$2,594.72
|
|
|
Service Code
|
HCPCS 36571
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$2,205.51 |
| Rate for Payer: AlohaCare Medicaid |
$309.32
|
| Rate for Payer: AlohaCare Medicare |
$291.56
|
| Rate for Payer: Cash Price |
$1,556.83
|
| Rate for Payer: Cash Price |
$1,556.83
|
| Rate for Payer: Devoted Health Medicare |
$320.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$309.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$489.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$309.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,399.06
|
| Rate for Payer: Health Management Network Commercial |
$2,205.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$349.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$349.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$349.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.56
|
|
|
PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 19342
|
| Min. Negotiated Rate |
$650.26 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: AlohaCare Medicaid |
$786.86
|
| Rate for Payer: AlohaCare Medicare |
$707.17
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Devoted Health Medicare |
$777.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$707.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$650.26
|
| Rate for Payer: Health Management Network Commercial |
$1,150.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$848.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$848.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$848.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$786.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$707.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$786.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$707.17
|
|
|
PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 33249
|
| Min. Negotiated Rate |
$776.76 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: AlohaCare Medicaid |
$886.39
|
| Rate for Payer: AlohaCare Medicare |
$776.76
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Devoted Health Medicare |
$854.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$776.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$837.72
|
| Rate for Payer: Health Management Network Commercial |
$1,286.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$932.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$932.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$932.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$886.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$776.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$886.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$776.76
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 33210
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$241.80 |
| Rate for Payer: AlohaCare Medicaid |
$153.07
|
| Rate for Payer: AlohaCare Medicare |
$134.18
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Devoted Health Medicare |
$147.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.18
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 33211
|
| Min. Negotiated Rate |
$139.09 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: AlohaCare Medicaid |
$160.25
|
| Rate for Payer: AlohaCare Medicare |
$139.09
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Devoted Health Medicare |
$153.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.28
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.09
|
|
|
PR INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 49435
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: AlohaCare Medicaid |
$111.36
|
| Rate for Payer: AlohaCare Medicare |
$99.74
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Devoted Health Medicare |
$109.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.74
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.74
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED
|
Professional
|
Both
|
$290.06
|
|
|
Service Code
|
HCPCS 51703
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$246.55 |
| Rate for Payer: Ohana Health Plan Medicaid |
$75.62
|
| Rate for Payer: AlohaCare Medicaid |
$75.62
|
| Rate for Payer: AlohaCare Medicare |
$66.63
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Devoted Health Medicare |
$73.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$122.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.24
|
| Rate for Payer: Health Management Network Commercial |
$246.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.63
|
| Rate for Payer: University Health Alliance Commercial |
$103.51
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE
|
Professional
|
Both
|
$124.06
|
|
|
Service Code
|
HCPCS 51702
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: AlohaCare Medicaid |
$25.03
|
| Rate for Payer: AlohaCare Medicare |
$22.28
|
| Rate for Payer: Cash Price |
$74.44
|
| Rate for Payer: Cash Price |
$74.44
|
| Rate for Payer: Devoted Health Medicare |
$24.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.34
|
| Rate for Payer: Health Management Network Commercial |
$105.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.28
|
| Rate for Payer: University Health Alliance Commercial |
$80.00
|
|
|
PR INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 37182
|
| Min. Negotiated Rate |
$686.92 |
| Max. Negotiated Rate |
$1,145.80 |
| Rate for Payer: AlohaCare Medicaid |
$785.17
|
| Rate for Payer: AlohaCare Medicare |
$686.92
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Devoted Health Medicare |
$755.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$686.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$864.24
|
| Rate for Payer: Health Management Network Commercial |
$1,145.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$824.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$824.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$824.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$785.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$686.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$785.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$686.92
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,840.12
|
|
|
Service Code
|
HCPCS 36561
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$1,564.10 |
| Rate for Payer: AlohaCare Medicaid |
$327.70
|
| Rate for Payer: AlohaCare Medicare |
$297.47
|
| Rate for Payer: Cash Price |
$1,104.07
|
| Rate for Payer: Cash Price |
$1,104.07
|
| Rate for Payer: Devoted Health Medicare |
$327.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$327.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$327.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,358.76
|
| Rate for Payer: Health Management Network Commercial |
$1,564.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$327.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.47
|
|
|
PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Professional
|
Both
|
$1,511.68
|
|
|
Service Code
|
HCPCS 36558
|
| Min. Negotiated Rate |
$231.89 |
| Max. Negotiated Rate |
$1,284.93 |
| Rate for Payer: AlohaCare Medicaid |
$256.53
|
| Rate for Payer: AlohaCare Medicare |
$231.89
|
| Rate for Payer: Cash Price |
$907.01
|
| Rate for Payer: Cash Price |
$907.01
|
| Rate for Payer: Devoted Health Medicare |
$255.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$403.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,012.44
|
| Rate for Payer: Health Management Network Commercial |
$1,284.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$278.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.89
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,627.62
|
|
|
Service Code
|
HCPCS 36565
|
| Min. Negotiated Rate |
$307.25 |
| Max. Negotiated Rate |
$1,383.48 |
| Rate for Payer: AlohaCare Medicaid |
$328.52
|
| Rate for Payer: AlohaCare Medicare |
$307.25
|
| Rate for Payer: Cash Price |
$976.57
|
| Rate for Payer: Cash Price |
$976.57
|
| Rate for Payer: Devoted Health Medicare |
$337.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$328.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$517.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$328.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,198.60
|
| Rate for Payer: Health Management Network Commercial |
$1,383.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$328.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$328.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.25
|
|
|
PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 33206
|
| Min. Negotiated Rate |
$395.01 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: AlohaCare Medicaid |
$445.97
|
| Rate for Payer: AlohaCare Medicare |
$395.01
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Devoted Health Medicare |
$434.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$420.42
|
| Rate for Payer: Health Management Network Commercial |
$648.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$474.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$474.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$474.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.01
|
|
|
PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 33208
|
| Min. Negotiated Rate |
$444.01 |
| Max. Negotiated Rate |
$731.00 |
| Rate for Payer: AlohaCare Medicaid |
$503.24
|
| Rate for Payer: AlohaCare Medicare |
$444.01
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Devoted Health Medicare |
$488.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$444.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$666.64
|
| Rate for Payer: Health Management Network Commercial |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$532.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$532.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$503.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$444.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$503.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$444.01
|
|
|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 33207
|
| Min. Negotiated Rate |
$412.03 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: AlohaCare Medicaid |
$465.57
|
| Rate for Payer: AlohaCare Medicare |
$412.03
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Devoted Health Medicare |
$453.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$497.12
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$494.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$494.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$465.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.03
|
|
|
PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS
|
Professional
|
Both
|
$530.78
|
|
|
Service Code
|
HCPCS 32560
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$451.16 |
| Rate for Payer: AlohaCare Medicaid |
$73.34
|
| Rate for Payer: AlohaCare Medicare |
$66.70
|
| Rate for Payer: Cash Price |
$318.47
|
| Rate for Payer: Cash Price |
$318.47
|
| Rate for Payer: Devoted Health Medicare |
$73.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$148.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.40
|
| Rate for Payer: Health Management Network Commercial |
$451.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.70
|
| Rate for Payer: University Health Alliance Commercial |
$99.59
|
|
|
PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY
|
Professional
|
Both
|
$185.59
|
|
|
Service Code
|
HCPCS 32561
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$157.75 |
| Rate for Payer: AlohaCare Medicaid |
$65.70
|
| Rate for Payer: AlohaCare Medicare |
$59.34
|
| Rate for Payer: Cash Price |
$111.35
|
| Rate for Payer: Cash Price |
$111.35
|
| Rate for Payer: Devoted Health Medicare |
$65.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$104.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.70
|
| Rate for Payer: Health Management Network Commercial |
$157.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.34
|
| Rate for Payer: University Health Alliance Commercial |
$88.85
|
|
|
PR INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 99177
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$30.01 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.01
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
|
|
PR INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 90887
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.69
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
|
|
PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 93261
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$75.30
|
| Rate for Payer: AlohaCare Medicare |
$75.33
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$82.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.19
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.33
|
|
|
PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 93261 TC
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: AlohaCare Medicaid |
$75.30
|
| Rate for Payer: AlohaCare Medicare |
$38.93
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$42.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.19
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.93
|
|
|
PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 93261 26
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: AlohaCare Medicaid |
$75.30
|
| Rate for Payer: AlohaCare Medicare |
$36.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$40.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.19
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.40
|
|
