|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$432.93
|
| Rate for Payer: AlohaCare Medicare |
$400.83
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$440.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$432.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.83
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$889.21
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$755.83 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$440.52
|
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Devoted Health Medicare |
$484.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$466.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$466.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$371.28
|
| Rate for Payer: Health Management Network Commercial |
$755.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$528.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.52
|
| Rate for Payer: University Health Alliance Commercial |
$582.41
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: AlohaCare Medicaid |
$105.64
|
| Rate for Payer: AlohaCare Medicare |
$99.01
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$108.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.11
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.01
|
| Rate for Payer: University Health Alliance Commercial |
$126.05
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$178.38
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$151.62 |
| Rate for Payer: AlohaCare Medicaid |
$75.74
|
| Rate for Payer: AlohaCare Medicare |
$70.79
|
| Rate for Payer: Cash Price |
$107.03
|
| Rate for Payer: Cash Price |
$107.03
|
| Rate for Payer: Devoted Health Medicare |
$77.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.79
|
| Rate for Payer: University Health Alliance Commercial |
$93.57
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$483.67 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: AlohaCare Medicaid |
$539.98
|
| Rate for Payer: AlohaCare Medicare |
$483.67
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Devoted Health Medicare |
$532.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$580.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$580.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$580.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$539.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$539.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.67
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$1,403.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$593.58 |
| Max. Negotiated Rate |
$1,192.55 |
| Rate for Payer: AlohaCare Medicaid |
$819.25
|
| Rate for Payer: AlohaCare Medicare |
$748.29
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Devoted Health Medicare |
$823.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$748.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$1,192.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$897.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$819.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$748.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$819.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$748.29
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,652.88
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,404.95 |
| Rate for Payer: AlohaCare Medicaid |
$697.58
|
| Rate for Payer: AlohaCare Medicare |
$628.53
|
| Rate for Payer: Cash Price |
$991.73
|
| Rate for Payer: Cash Price |
$991.73
|
| Rate for Payer: Devoted Health Medicare |
$691.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$697.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,077.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$628.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$697.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network Commercial |
$1,404.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$754.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$754.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$697.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$697.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.53
|
| Rate for Payer: University Health Alliance Commercial |
$796.98
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$506.66
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$430.66 |
| Rate for Payer: AlohaCare Medicaid |
$114.03
|
| Rate for Payer: AlohaCare Medicare |
$101.54
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Devoted Health Medicare |
$111.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.90
|
| Rate for Payer: Health Management Network Commercial |
$430.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.54
|
| Rate for Payer: University Health Alliance Commercial |
$141.68
|
|
|
PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS
|
Professional
|
Both
|
$778.78
|
|
|
Service Code
|
HCPCS 47531
|
| Min. Negotiated Rate |
$61.84 |
| Max. Negotiated Rate |
$661.96 |
| Rate for Payer: AlohaCare Medicaid |
$69.80
|
| Rate for Payer: AlohaCare Medicare |
$61.84
|
| Rate for Payer: Cash Price |
$467.27
|
| Rate for Payer: Cash Price |
$467.27
|
| Rate for Payer: Devoted Health Medicare |
$68.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.92
|
| Rate for Payer: Health Management Network Commercial |
$661.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.84
|
| Rate for Payer: University Health Alliance Commercial |
$87.08
|
|
|
PR NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS
|
Professional
|
Both
|
$1,562.50
|
|
|
Service Code
|
HCPCS 47532
|
| Min. Negotiated Rate |
$179.66 |
| Max. Negotiated Rate |
$1,328.12 |
| Rate for Payer: AlohaCare Medicaid |
$204.56
|
| Rate for Payer: AlohaCare Medicare |
$179.66
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Devoted Health Medicare |
$197.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$204.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$323.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$204.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$937.04
|
| Rate for Payer: Health Management Network Commercial |
$1,328.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$215.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.66
|
| Rate for Payer: University Health Alliance Commercial |
$255.27
|
|
|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$403.55
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$343.02 |
| Rate for Payer: AlohaCare Medicaid |
$42.83
|
| Rate for Payer: AlohaCare Medicare |
$36.92
|
| Rate for Payer: Cash Price |
$242.13
|
| Rate for Payer: Cash Price |
$242.13
|
| Rate for Payer: Devoted Health Medicare |
$40.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$67.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.10
|
| Rate for Payer: Health Management Network Commercial |
$343.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.92
|
|
|
PR NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY
|
Professional
|
Both
|
$78.30
|
|
|
Service Code
|
HCPCS 93568
|
| Min. Negotiated Rate |
$38.66 |
| Max. Negotiated Rate |
$176.72 |
| Rate for Payer: AlohaCare Medicaid |
$44.13
|
| Rate for Payer: AlohaCare Medicare |
$38.66
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Cash Price |
$46.98
|
| Rate for Payer: Devoted Health Medicare |
$42.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$176.72
|
| Rate for Payer: Health Management Network Commercial |
$66.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.66
|
|
|
PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$44.66
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$43.33 |
| Rate for Payer: AlohaCare Medicaid |
$25.39
|
| Rate for Payer: AlohaCare Medicare |
$22.11
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Devoted Health Medicare |
$24.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.33
|
| Rate for Payer: Health Management Network Commercial |
$37.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.11
|
|
|
PR NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$43.98
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$198.41 |
| Rate for Payer: AlohaCare Medicaid |
$24.83
|
| Rate for Payer: AlohaCare Medicare |
$21.71
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Devoted Health Medicare |
$23.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.41
|
| Rate for Payer: Health Management Network Commercial |
$37.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.71
|
|
|
PR NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I
|
Professional
|
Both
|
$62.44
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$160.95 |
| Rate for Payer: AlohaCare Medicaid |
$35.47
|
| Rate for Payer: AlohaCare Medicare |
$30.74
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Devoted Health Medicare |
$33.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.95
|
| Rate for Payer: Health Management Network Commercial |
$53.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.74
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$362.41
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$308.05 |
| Rate for Payer: AlohaCare Medicaid |
$92.79
|
| Rate for Payer: AlohaCare Medicare |
$83.28
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Devoted Health Medicare |
$91.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$164.84
|
| Rate for Payer: Health Management Network Commercial |
$308.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.28
|
| Rate for Payer: University Health Alliance Commercial |
$115.68
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$445.40 |
| Rate for Payer: AlohaCare Medicaid |
$100.76
|
| Rate for Payer: AlohaCare Medicare |
$90.18
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Devoted Health Medicare |
$99.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$100.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$155.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$100.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.26
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.18
|
| Rate for Payer: University Health Alliance Commercial |
$125.06
|
|
|
PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$2,623.65
|
|
|
Service Code
|
HCPCS 36466
|
| Min. Negotiated Rate |
$127.12 |
| Max. Negotiated Rate |
$2,230.10 |
| Rate for Payer: AlohaCare Medicaid |
$143.77
|
| Rate for Payer: AlohaCare Medicare |
$127.12
|
| Rate for Payer: Cash Price |
$1,574.19
|
| Rate for Payer: Cash Price |
$1,574.19
|
| Rate for Payer: Devoted Health Medicare |
$139.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$143.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$232.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$143.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,917.76
|
| Rate for Payer: Health Management Network Commercial |
$2,230.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.12
|
| Rate for Payer: University Health Alliance Commercial |
$178.13
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$600.93
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$510.79 |
| Rate for Payer: AlohaCare Medicaid |
$66.78
|
| Rate for Payer: AlohaCare Medicare |
$60.09
|
| Rate for Payer: Cash Price |
$360.56
|
| Rate for Payer: Cash Price |
$360.56
|
| Rate for Payer: Devoted Health Medicare |
$66.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$183.56
|
| Rate for Payer: Health Management Network Commercial |
$510.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.09
|
| Rate for Payer: University Health Alliance Commercial |
$102.00
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$1,194.43
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$1,015.27 |
| Rate for Payer: AlohaCare Medicaid |
$151.66
|
| Rate for Payer: AlohaCare Medicare |
$134.90
|
| Rate for Payer: Cash Price |
$716.66
|
| Rate for Payer: Cash Price |
$716.66
|
| Rate for Payer: Devoted Health Medicare |
$148.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.32
|
| Rate for Payer: Health Management Network Commercial |
$1,015.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.90
|
| Rate for Payer: University Health Alliance Commercial |
$200.84
|
|
|
PR NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE
|
Professional
|
Both
|
$353.59
|
|
|
Service Code
|
HCPCS 27369
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$300.55 |
| Rate for Payer: AlohaCare Medicaid |
$39.93
|
| Rate for Payer: AlohaCare Medicare |
$33.81
|
| Rate for Payer: Cash Price |
$212.15
|
| Rate for Payer: Cash Price |
$212.15
|
| Rate for Payer: Devoted Health Medicare |
$37.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$61.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.98
|
| Rate for Payer: Health Management Network Commercial |
$300.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.81
|
| Rate for Payer: University Health Alliance Commercial |
$55.00
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$474.48
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$40.23 |
| Max. Negotiated Rate |
$403.31 |
| Rate for Payer: AlohaCare Medicaid |
$45.32
|
| Rate for Payer: AlohaCare Medicare |
$40.23
|
| Rate for Payer: Cash Price |
$284.69
|
| Rate for Payer: Cash Price |
$284.69
|
| Rate for Payer: Devoted Health Medicare |
$44.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$72.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.46
|
| Rate for Payer: Health Management Network Commercial |
$403.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.23
|
| Rate for Payer: University Health Alliance Commercial |
$61.39
|
|
|
PR NJX RETROGRADE URETHROCSTOGRAPY
|
Professional
|
Both
|
$243.13
|
|
|
Service Code
|
HCPCS 51610
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$206.66 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$58.80
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Devoted Health Medicare |
$64.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$100.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$206.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.80
|
| Rate for Payer: University Health Alliance Commercial |
$85.04
|
|
|
PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG
|
Professional
|
Both
|
$220.31
|
|
|
Service Code
|
HCPCS 50690
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: AlohaCare Medicaid |
$71.07
|
| Rate for Payer: AlohaCare Medicare |
$63.23
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Devoted Health Medicare |
$69.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$109.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$187.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.23
|
| Rate for Payer: University Health Alliance Commercial |
$92.43
|
|
|
PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 93922 TC
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$92.25
|
| Rate for Payer: AlohaCare Medicare |
$80.90
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Devoted Health Medicare |
$88.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.63
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.90
|
|
