|
PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 93292
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: AlohaCare Medicaid |
$55.80
|
| Rate for Payer: AlohaCare Medicare |
$56.19
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$61.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.19
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.19
|
|
|
PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 93292 TC
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: AlohaCare Medicaid |
$55.80
|
| Rate for Payer: AlohaCare Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Devoted Health Medicare |
$38.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.13
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.13
|
|
|
PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93292 26
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: UnitedHealthcare Medicare |
$21.06
|
| Rate for Payer: AlohaCare Medicaid |
$55.80
|
| Rate for Payer: AlohaCare Medicare |
$21.06
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.06
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.80
|
|
|
PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB
|
Professional
|
Both
|
$64.38
|
|
|
Service Code
|
HCPCS 93295
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$63.33 |
| Rate for Payer: AlohaCare Medicaid |
$36.66
|
| Rate for Payer: AlohaCare Medicare |
$36.79
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Devoted Health Medicare |
$40.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.33
|
| Rate for Payer: Health Management Network Commercial |
$54.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.79
|
|
|
PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 93290 TC
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: AlohaCare Medicaid |
$58.09
|
| Rate for Payer: AlohaCare Medicare |
$36.27
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Devoted Health Medicare |
$39.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.69
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.27
|
|
|
PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 93290
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: AlohaCare Medicaid |
$58.09
|
| Rate for Payer: AlohaCare Medicare |
$57.33
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$63.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.69
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.33
|
|
|
PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93290 26
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$58.09 |
| Rate for Payer: AlohaCare Medicaid |
$58.09
|
| Rate for Payer: AlohaCare Medicare |
$21.06
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$23.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.69
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.06
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 93288
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: AlohaCare Medicaid |
$61.73
|
| Rate for Payer: AlohaCare Medicare |
$60.75
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Devoted Health Medicare |
$66.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.68
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.75
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 93288 26
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: AlohaCare Medicaid |
$61.73
|
| Rate for Payer: AlohaCare Medicare |
$20.68
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Devoted Health Medicare |
$22.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.68
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.68
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 93288 TC
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$61.73
|
| Rate for Payer: AlohaCare Medicare |
$40.07
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$44.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.68
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.07
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 93291 26
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$53.61 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$17.91
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$19.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.91
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 93291 TC
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$34.75
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.75
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93291
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$52.67
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$57.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.67
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 93289 TC
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$40.45
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$44.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.45
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 93289 26
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$77.73 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$40.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.36
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 93289
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$76.80
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Devoted Health Medicare |
$84.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.80
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$706.62
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$600.63 |
| Rate for Payer: AlohaCare Medicaid |
$402.86
|
| Rate for Payer: AlohaCare Medicare |
$403.78
|
| Rate for Payer: Cash Price |
$423.97
|
| Rate for Payer: Cash Price |
$423.97
|
| Rate for Payer: Devoted Health Medicare |
$444.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$369.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$403.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.26
|
| Rate for Payer: Health Management Network Commercial |
$600.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$484.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.78
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$648.11
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$550.89 |
| Rate for Payer: AlohaCare Medicaid |
$362.75
|
| Rate for Payer: AlohaCare Medicare |
$370.35
|
| Rate for Payer: Cash Price |
$388.87
|
| Rate for Payer: Cash Price |
$388.87
|
| Rate for Payer: Devoted Health Medicare |
$407.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$376.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$370.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$550.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$444.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$444.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$444.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$362.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$370.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$362.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$370.35
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$249.66
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$117.59 |
| Max. Negotiated Rate |
$212.21 |
| Rate for Payer: AlohaCare Medicaid |
$132.48
|
| Rate for Payer: AlohaCare Medicare |
$117.59
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: Devoted Health Medicare |
$129.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.44
|
| Rate for Payer: Health Management Network Commercial |
$212.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.59
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$817.34
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$694.74 |
| Rate for Payer: AlohaCare Medicaid |
$301.91
|
| Rate for Payer: AlohaCare Medicare |
$274.89
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Devoted Health Medicare |
$302.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$301.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$274.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$301.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.10
|
| Rate for Payer: Health Management Network Commercial |
$694.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$329.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$329.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$301.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$274.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$301.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$274.89
|
| Rate for Payer: University Health Alliance Commercial |
$387.74
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE
|
Professional
|
Both
|
$633.18
|
|
|
Service Code
|
HCPCS 41007
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: AlohaCare Medicaid |
$232.79
|
| Rate for Payer: AlohaCare Medicare |
$213.71
|
| Rate for Payer: Cash Price |
$379.91
|
| Rate for Payer: Cash Price |
$379.91
|
| Rate for Payer: Devoted Health Medicare |
$235.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$353.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$232.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.92
|
| Rate for Payer: Health Management Network Commercial |
$538.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.71
|
| Rate for Payer: University Health Alliance Commercial |
$299.25
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$781.80
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$664.53 |
| Rate for Payer: AlohaCare Medicaid |
$271.80
|
| Rate for Payer: AlohaCare Medicare |
$253.82
|
| Rate for Payer: Cash Price |
$469.08
|
| Rate for Payer: Cash Price |
$469.08
|
| Rate for Payer: Devoted Health Medicare |
$279.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$271.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$411.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$253.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$271.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.32
|
| Rate for Payer: Health Management Network Commercial |
$664.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$304.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$304.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$253.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$271.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$253.82
|
| Rate for Payer: University Health Alliance Commercial |
$348.81
|
|
|
PR INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
|
|
PR INTRAVASCULAR LITHOTRIPSY FPVT W/IN SAME ARTERY
|
Professional
|
Both
|
$9,166.00
|
|
|
Service Code
|
HCPCS 37279
|
| Min. Negotiated Rate |
$173.19 |
| Max. Negotiated Rate |
$7,791.10 |
| Rate for Payer: AlohaCare Medicare |
$173.19
|
| Rate for Payer: Cash Price |
$5,499.60
|
| Rate for Payer: Cash Price |
$5,499.60
|
| Rate for Payer: Devoted Health Medicare |
$190.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.19
|
| Rate for Payer: Health Management Network Commercial |
$7,791.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.19
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$317.94
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: AlohaCare Medicaid |
$66.36
|
| Rate for Payer: AlohaCare Medicare |
$59.39
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Devoted Health Medicare |
$65.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.84
|
| Rate for Payer: Health Management Network Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.39
|
| Rate for Payer: University Health Alliance Commercial |
$89.42
|
|
