|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$3,006.00
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$1,543.11 |
| Max. Negotiated Rate |
$2,555.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,753.19
|
| Rate for Payer: AlohaCare Medicare |
$1,543.11
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Devoted Health Medicare |
$1,697.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,543.11
|
| Rate for Payer: Health Management Network Commercial |
$2,555.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,851.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,851.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,753.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,543.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,753.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,543.11
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$2,789.00
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$1,434.86 |
| Max. Negotiated Rate |
$2,370.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,626.67
|
| Rate for Payer: AlohaCare Medicare |
$1,434.86
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Devoted Health Medicare |
$1,578.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,434.86
|
| Rate for Payer: Health Management Network Commercial |
$2,370.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,721.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,721.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,721.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,626.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,434.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,626.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,434.86
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$487.24 |
| Max. Negotiated Rate |
$1,523.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,046.20
|
| Rate for Payer: AlohaCare Medicare |
$975.11
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Devoted Health Medicare |
$1,072.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$975.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.24
|
| Rate for Payer: Health Management Network Commercial |
$1,523.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,170.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,170.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,170.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,046.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$975.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,046.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$975.11
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: AlohaCare Medicaid |
$639.76
|
| Rate for Payer: AlohaCare Medicare |
$611.54
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Devoted Health Medicare |
$672.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$611.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.50
|
| Rate for Payer: Health Management Network Commercial |
$928.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$733.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$733.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$733.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$639.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$611.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$639.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$611.54
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$572.26 |
| Max. Negotiated Rate |
$1,706.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,172.63
|
| Rate for Payer: AlohaCare Medicare |
$1,084.72
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Devoted Health Medicare |
$1,193.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,084.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$572.26
|
| Rate for Payer: Health Management Network Commercial |
$1,706.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,301.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,301.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,301.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,172.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,084.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,172.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,084.72
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$1,889.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$1,021.71 |
| Max. Negotiated Rate |
$1,605.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,111.49
|
| Rate for Payer: AlohaCare Medicare |
$1,021.71
|
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Devoted Health Medicare |
$1,123.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,021.71
|
| Rate for Payer: Health Management Network Commercial |
$1,605.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,226.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,226.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,226.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,111.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,021.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,111.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,021.71
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$2,743.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$918.84 |
| Max. Negotiated Rate |
$2,331.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,601.90
|
| Rate for Payer: AlohaCare Medicare |
$1,470.56
|
| Rate for Payer: Cash Price |
$1,645.80
|
| Rate for Payer: Cash Price |
$1,645.80
|
| Rate for Payer: Devoted Health Medicare |
$1,617.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,470.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$918.84
|
| Rate for Payer: Health Management Network Commercial |
$2,331.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,764.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,764.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,764.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,601.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,470.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,601.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,470.56
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$269.88 |
| Max. Negotiated Rate |
$875.50 |
| Rate for Payer: AlohaCare Medicaid |
$603.14
|
| Rate for Payer: AlohaCare Medicare |
$566.84
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Devoted Health Medicare |
$623.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.88
|
| Rate for Payer: Health Management Network Commercial |
$875.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$680.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$680.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$680.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$603.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$603.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.84
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$660.61 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$717.91
|
| Rate for Payer: AlohaCare Medicare |
$660.61
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$726.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$660.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$702.26
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$792.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$792.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$717.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$660.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$717.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$660.61
|
| Rate for Payer: University Health Alliance Commercial |
$968.81
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$1,304.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$626.60 |
| Max. Negotiated Rate |
$1,108.40 |
| Rate for Payer: AlohaCare Medicaid |
$764.46
|
| Rate for Payer: AlohaCare Medicare |
$705.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Devoted Health Medicare |
$775.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$705.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.60
|
| Rate for Payer: Health Management Network Commercial |
$1,108.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$846.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$846.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$846.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$764.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$705.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$764.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$705.40
|
|
|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$1,502.00
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$744.17 |
| Max. Negotiated Rate |
$1,276.70 |
| Rate for Payer: AlohaCare Medicaid |
$878.72
|
| Rate for Payer: AlohaCare Medicare |
$744.17
|
| Rate for Payer: Cash Price |
$901.20
|
| Rate for Payer: Cash Price |
$901.20
|
| Rate for Payer: Devoted Health Medicare |
$818.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$744.17
|
| Rate for Payer: Health Management Network Commercial |
$1,276.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$893.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$893.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$878.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$744.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$878.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$744.17
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$1,215.50 |
| Max. Negotiated Rate |
$2,081.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,426.06
|
| Rate for Payer: AlohaCare Medicare |
$1,274.28
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Devoted Health Medicare |
$1,401.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,274.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,215.50
|
| Rate for Payer: Health Management Network Commercial |
$2,081.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,529.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,529.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,529.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,426.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,274.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,426.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,274.28
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$1,675.58 |
| Max. Negotiated Rate |
$2,784.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,909.31
|
| Rate for Payer: AlohaCare Medicare |
$1,675.58
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Devoted Health Medicare |
$1,843.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,675.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,779.96
|
| Rate for Payer: Health Management Network Commercial |
$2,784.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,010.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,010.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,010.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,909.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,675.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,909.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,675.58
|
|
|
PR REVJ TRANSVNS INTRHPTC PORTOSYSTEMIC SHNT (TIPS)
|
Professional
|
Both
|
$10,674.26
|
|
|
Service Code
|
HCPCS 37183
|
| Min. Negotiated Rate |
$315.71 |
| Max. Negotiated Rate |
$9,073.12 |
| Rate for Payer: AlohaCare Medicaid |
$360.94
|
| Rate for Payer: AlohaCare Medicare |
$315.71
|
| Rate for Payer: Cash Price |
$6,404.56
|
| Rate for Payer: Cash Price |
$6,404.56
|
| Rate for Payer: Devoted Health Medicare |
$347.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$360.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$570.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$315.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$360.94
|
| Rate for Payer: Health Management Network Commercial |
$9,073.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$378.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$378.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$360.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$315.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$360.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$315.71
|
| Rate for Payer: University Health Alliance Commercial |
$492.98
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$1,037.85 |
| Rate for Payer: AlohaCare Medicaid |
$712.09
|
| Rate for Payer: AlohaCare Medicare |
$641.71
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Devoted Health Medicare |
$705.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$573.56
|
| Rate for Payer: Health Management Network Commercial |
$1,037.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$770.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$770.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$712.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$712.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.71
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$764.15 |
| Rate for Payer: AlohaCare Medicaid |
$526.41
|
| Rate for Payer: AlohaCare Medicare |
$480.90
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Devoted Health Medicare |
$528.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$396.50
|
| Rate for Payer: Health Management Network Commercial |
$764.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$577.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$577.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$577.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$526.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$526.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.90
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$644.95
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$86.84 |
| Max. Negotiated Rate |
$548.21 |
| Rate for Payer: AlohaCare Medicaid |
$233.77
|
| Rate for Payer: AlohaCare Medicare |
$211.31
|
| Rate for Payer: Cash Price |
$386.97
|
| Rate for Payer: Cash Price |
$386.97
|
| Rate for Payer: Devoted Health Medicare |
$232.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$233.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$220.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$233.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.84
|
| Rate for Payer: Health Management Network Commercial |
$548.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$253.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$253.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$253.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.31
|
| Rate for Payer: University Health Alliance Commercial |
$171.83
|
|
|
PR REVSC EVASC FPVT ANGIOP UNI CPLX LES 1ST VSL
|
Professional
|
Both
|
$22,773.00
|
|
|
Service Code
|
HCPCS 37265
|
| Min. Negotiated Rate |
$453.36 |
| Max. Negotiated Rate |
$19,357.05 |
| Rate for Payer: AlohaCare Medicare |
$453.36
|
| Rate for Payer: Cash Price |
$13,663.80
|
| Rate for Payer: Cash Price |
$13,663.80
|
| Rate for Payer: Devoted Health Medicare |
$498.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$453.36
|
| Rate for Payer: Health Management Network Commercial |
$19,357.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$544.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$544.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$453.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$453.36
|
|
|
PR REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL
|
Professional
|
Both
|
$10,682.00
|
|
|
Service Code
|
HCPCS 37263
|
| Min. Negotiated Rate |
$335.26 |
| Max. Negotiated Rate |
$9,079.70 |
| Rate for Payer: AlohaCare Medicare |
$335.26
|
| Rate for Payer: Cash Price |
$6,409.20
|
| Rate for Payer: Cash Price |
$6,409.20
|
| Rate for Payer: Devoted Health Medicare |
$368.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$335.26
|
| Rate for Payer: Health Management Network Commercial |
$9,079.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$402.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$402.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$335.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$335.26
|
|
|
PR REVSC EVASC FPVT ANGIOP UNI SF LES EA ADDL VSL
|
Professional
|
Both
|
$4,298.00
|
|
|
Service Code
|
HCPCS 37264
|
| Min. Negotiated Rate |
$128.17 |
| Max. Negotiated Rate |
$3,653.30 |
| Rate for Payer: AlohaCare Medicare |
$128.17
|
| Rate for Payer: Cash Price |
$2,578.80
|
| Rate for Payer: Cash Price |
$2,578.80
|
| Rate for Payer: Devoted Health Medicare |
$140.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.17
|
| Rate for Payer: Health Management Network Commercial |
$3,653.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.17
|
|
|
PR REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL
|
Professional
|
Both
|
$30,478.00
|
|
|
Service Code
|
HCPCS 37273
|
| Min. Negotiated Rate |
$544.93 |
| Max. Negotiated Rate |
$25,906.30 |
| Rate for Payer: AlohaCare Medicare |
$544.93
|
| Rate for Payer: Cash Price |
$18,286.80
|
| Rate for Payer: Cash Price |
$18,286.80
|
| Rate for Payer: Devoted Health Medicare |
$599.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$544.93
|
| Rate for Payer: Health Management Network Commercial |
$25,906.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$653.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$653.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$653.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$544.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$544.93
|
|
|
PR REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL
|
Professional
|
Both
|
$20,293.00
|
|
|
Service Code
|
HCPCS 37271
|
| Min. Negotiated Rate |
$389.42 |
| Max. Negotiated Rate |
$17,249.05 |
| Rate for Payer: AlohaCare Medicare |
$389.42
|
| Rate for Payer: Cash Price |
$12,175.80
|
| Rate for Payer: Cash Price |
$12,175.80
|
| Rate for Payer: Devoted Health Medicare |
$428.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.42
|
| Rate for Payer: Health Management Network Commercial |
$17,249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$467.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$467.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$467.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.42
|
|
|
PR REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL
|
Professional
|
Both
|
$30,478.00
|
|
|
Service Code
|
HCPCS 37277
|
| Min. Negotiated Rate |
$642.91 |
| Max. Negotiated Rate |
$25,906.30 |
| Rate for Payer: AlohaCare Medicare |
$642.91
|
| Rate for Payer: Cash Price |
$18,286.80
|
| Rate for Payer: Cash Price |
$18,286.80
|
| Rate for Payer: Devoted Health Medicare |
$707.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$642.91
|
| Rate for Payer: Health Management Network Commercial |
$25,906.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$771.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$771.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$771.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$642.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$642.91
|
|
|
PR REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL
|
Professional
|
Both
|
$20,293.00
|
|
|
Service Code
|
HCPCS 37275
|
| Min. Negotiated Rate |
$472.92 |
| Max. Negotiated Rate |
$17,249.05 |
| Rate for Payer: AlohaCare Medicare |
$472.92
|
| Rate for Payer: Cash Price |
$12,175.80
|
| Rate for Payer: Cash Price |
$12,175.80
|
| Rate for Payer: Devoted Health Medicare |
$520.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.92
|
| Rate for Payer: Health Management Network Commercial |
$17,249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$567.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$567.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.92
|
|
|
PR REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL
|
Professional
|
Both
|
$26,151.00
|
|
|
Service Code
|
HCPCS 37269
|
| Min. Negotiated Rate |
$633.85 |
| Max. Negotiated Rate |
$22,228.35 |
| Rate for Payer: AlohaCare Medicare |
$633.85
|
| Rate for Payer: Cash Price |
$15,690.60
|
| Rate for Payer: Cash Price |
$15,690.60
|
| Rate for Payer: Devoted Health Medicare |
$697.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$633.85
|
| Rate for Payer: Health Management Network Commercial |
$22,228.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$760.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$760.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$760.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$633.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$633.85
|
|
