|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$1,756.95
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$75.06 |
| Max. Negotiated Rate |
$1,638.78 |
| Rate for Payer: AlohaCare Medicaid |
$83.28
|
| Rate for Payer: AlohaCare Medicare |
$75.06
|
| Rate for Payer: Cash Price |
$1,054.17
|
| Rate for Payer: Cash Price |
$1,054.17
|
| Rate for Payer: Devoted Health Medicare |
$82.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,638.78
|
| Rate for Payer: Health Management Network Commercial |
$1,493.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.06
|
| Rate for Payer: University Health Alliance Commercial |
$112.60
|
|
|
PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 67028
|
| Min. Negotiated Rate |
$77.37 |
| Max. Negotiated Rate |
$201.99 |
| Rate for Payer: AlohaCare Medicaid |
$94.36
|
| Rate for Payer: AlohaCare Medicare |
$77.37
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Devoted Health Medicare |
$85.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$201.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.37
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: AlohaCare Medicaid |
$126.81
|
| Rate for Payer: AlohaCare Medicare |
$109.22
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$120.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$126.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$185.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$126.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.44
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.22
|
| Rate for Payer: University Health Alliance Commercial |
$167.68
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$1,323.51
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$1,124.98 |
| Rate for Payer: AlohaCare Medicaid |
$160.76
|
| Rate for Payer: AlohaCare Medicare |
$142.96
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Devoted Health Medicare |
$157.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$160.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$255.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.58
|
| Rate for Payer: Health Management Network Commercial |
$1,124.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.96
|
| Rate for Payer: University Health Alliance Commercial |
$230.00
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$9,480.03
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$267.88 |
| Max. Negotiated Rate |
$8,058.03 |
| Rate for Payer: AlohaCare Medicaid |
$299.64
|
| Rate for Payer: AlohaCare Medicare |
$267.88
|
| Rate for Payer: Cash Price |
$5,688.02
|
| Rate for Payer: Cash Price |
$5,688.02
|
| Rate for Payer: Devoted Health Medicare |
$294.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$299.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$477.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$267.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$299.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,484.92
|
| Rate for Payer: Health Management Network Commercial |
$8,058.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$267.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$267.88
|
| Rate for Payer: University Health Alliance Commercial |
$420.66
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$2,309.41
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$203.90 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: AlohaCare Medicaid |
$229.30
|
| Rate for Payer: AlohaCare Medicare |
$203.90
|
| Rate for Payer: Cash Price |
$1,385.65
|
| Rate for Payer: Cash Price |
$1,385.65
|
| Rate for Payer: Devoted Health Medicare |
$224.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$229.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$229.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,388.40
|
| Rate for Payer: Health Management Network Commercial |
$1,963.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.90
|
| Rate for Payer: University Health Alliance Commercial |
$308.42
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$1,283.50 |
| Rate for Payer: AlohaCare Medicaid |
$121.02
|
| Rate for Payer: AlohaCare Medicare |
$108.89
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Devoted Health Medicare |
$119.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$121.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$1,283.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.89
|
| Rate for Payer: University Health Alliance Commercial |
$160.34
|
|
|
PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA
|
Professional
|
Both
|
$989.73
|
|
|
Service Code
|
HCPCS 36010
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$841.27 |
| Rate for Payer: AlohaCare Medicaid |
$102.60
|
| Rate for Payer: AlohaCare Medicare |
$90.85
|
| Rate for Payer: Cash Price |
$593.84
|
| Rate for Payer: Cash Price |
$593.84
|
| Rate for Payer: Devoted Health Medicare |
$99.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$841.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.85
|
| Rate for Payer: University Health Alliance Commercial |
$138.98
|
|
|
PR INTRODUCTION CATHETER AORTA
|
Professional
|
Both
|
$1,085.98
|
|
|
Service Code
|
HCPCS 36200
|
| Min. Negotiated Rate |
$115.84 |
| Max. Negotiated Rate |
$923.08 |
| Rate for Payer: AlohaCare Medicaid |
$129.99
|
| Rate for Payer: AlohaCare Medicare |
$115.84
|
| Rate for Payer: Cash Price |
$651.59
|
| Rate for Payer: Cash Price |
$651.59
|
| Rate for Payer: Devoted Health Medicare |
$127.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$210.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.70
|
| Rate for Payer: Health Management Network Commercial |
$923.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.84
|
| Rate for Payer: University Health Alliance Commercial |
$211.00
|
|
|
PR INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 36000
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: AlohaCare Medicaid |
$9.04
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.04
|
|
|
PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY
|
Professional
|
Both
|
$969.06
|
|
|
Service Code
|
HCPCS 36140
|
| Min. Negotiated Rate |
$74.86 |
| Max. Negotiated Rate |
$823.70 |
| Rate for Payer: AlohaCare Medicaid |
$83.67
|
| Rate for Payer: AlohaCare Medicare |
$74.86
|
| Rate for Payer: Cash Price |
$581.44
|
| Rate for Payer: Cash Price |
$581.44
|
| Rate for Payer: Devoted Health Medicare |
$82.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.94
|
| Rate for Payer: Health Management Network Commercial |
$823.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.86
|
| Rate for Payer: University Health Alliance Commercial |
$113.63
|
|
|
PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 44615
|
| Min. Negotiated Rate |
$620.62 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,052.87
|
| Rate for Payer: AlohaCare Medicare |
$973.13
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Devoted Health Medicare |
$1,070.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$973.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$620.62
|
| Rate for Payer: Health Management Network Commercial |
$1,534.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,167.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,167.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,167.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,052.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$973.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,052.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$973.13
|
|
|
PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 31500
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: AlohaCare Medicaid |
$136.20
|
| Rate for Payer: AlohaCare Medicare |
$128.79
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$141.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$154.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.79
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 99255
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99253
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.55
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 99254
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.07
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99252
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.22
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
|
|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$51.19
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: AlohaCare Medicaid |
$16.97
|
| Rate for Payer: AlohaCare Medicare |
$29.25
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Devoted Health Medicare |
$32.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.86
|
| Rate for Payer: Health Management Network Commercial |
$43.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.25
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$468.84
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: AlohaCare Medicaid |
$133.92
|
| Rate for Payer: AlohaCare Medicare |
$128.54
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Devoted Health Medicare |
$141.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$205.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$398.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$154.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.54
|
| Rate for Payer: University Health Alliance Commercial |
$174.16
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 93571 26
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$219.12 |
| Rate for Payer: AlohaCare Medicaid |
$219.12
|
| Rate for Payer: AlohaCare Medicare |
$90.81
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$99.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.81
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$219.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.81
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 93572 26
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$170.28 |
| Rate for Payer: AlohaCare Medicaid |
$170.28
|
| Rate for Payer: AlohaCare Medicare |
$72.11
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$79.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.11
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.11
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$24.87
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: AlohaCare Medicaid |
$8.11
|
| Rate for Payer: AlohaCare Medicare |
$14.21
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Devoted Health Medicare |
$15.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.68
|
| Rate for Payer: Health Management Network Commercial |
$21.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.21
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$64.77
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: AlohaCare Medicaid |
$21.64
|
| Rate for Payer: AlohaCare Medicare |
$37.01
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Devoted Health Medicare |
$40.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.83
|
| Rate for Payer: Health Management Network Commercial |
$55.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.01
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$130.60
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$111.01 |
| Rate for Payer: AlohaCare Medicaid |
$42.05
|
| Rate for Payer: AlohaCare Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$78.36
|
| Rate for Payer: Cash Price |
$78.36
|
| Rate for Payer: Devoted Health Medicare |
$82.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.23
|
| Rate for Payer: Health Management Network Commercial |
$111.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.63
|
|
|
PR KO ELASTIC W/JOINTS PRE OTS
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS L1812
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: AlohaCare Medicaid |
$127.95
|
| Rate for Payer: AlohaCare Medicare |
$126.23
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Devoted Health Medicare |
$138.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$129.87
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.23
|
|
