|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$466.86
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$396.83 |
| Rate for Payer: AlohaCare Medicaid |
$138.73
|
| Rate for Payer: AlohaCare Medicare |
$127.78
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Devoted Health Medicare |
$140.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$303.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$396.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.78
|
| Rate for Payer: University Health Alliance Commercial |
$163.91
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$300.35
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$255.30 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$69.47
|
| Rate for Payer: Cash Price |
$180.21
|
| Rate for Payer: Cash Price |
$180.21
|
| Rate for Payer: Devoted Health Medicare |
$76.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.06
|
| Rate for Payer: Health Management Network Commercial |
$255.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.47
|
| Rate for Payer: University Health Alliance Commercial |
$82.18
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 51736 26
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$8.72
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Devoted Health Medicare |
$9.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.72
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$15.37
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Devoted Health Medicare |
$16.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.37
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 51736 TC
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$6.65
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Devoted Health Medicare |
$7.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.65
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$2,369.94
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$214.76 |
| Max. Negotiated Rate |
$2,014.45 |
| Rate for Payer: AlohaCare Medicaid |
$242.02
|
| Rate for Payer: AlohaCare Medicare |
$214.76
|
| Rate for Payer: Cash Price |
$1,421.96
|
| Rate for Payer: Cash Price |
$1,421.96
|
| Rate for Payer: Devoted Health Medicare |
$236.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$242.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$242.02
|
| Rate for Payer: Health Management Network Commercial |
$2,014.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.76
|
| Rate for Payer: University Health Alliance Commercial |
$393.00
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$2,574.11
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$2,187.99 |
| Rate for Payer: AlohaCare Medicaid |
$336.33
|
| Rate for Payer: AlohaCare Medicare |
$294.40
|
| Rate for Payer: Cash Price |
$1,544.47
|
| Rate for Payer: Cash Price |
$1,544.47
|
| Rate for Payer: Devoted Health Medicare |
$323.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$336.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$538.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$294.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$336.33
|
| Rate for Payer: Health Management Network Commercial |
$2,187.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$353.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$353.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$336.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$294.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$336.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$294.40
|
| Rate for Payer: University Health Alliance Commercial |
$456.12
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$3,713.41
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$280.45 |
| Max. Negotiated Rate |
$3,156.40 |
| Rate for Payer: AlohaCare Medicaid |
$311.53
|
| Rate for Payer: AlohaCare Medicare |
$280.45
|
| Rate for Payer: Cash Price |
$2,228.05
|
| Rate for Payer: Cash Price |
$2,228.05
|
| Rate for Payer: Devoted Health Medicare |
$308.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$311.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$485.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$280.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$311.53
|
| Rate for Payer: Health Management Network Commercial |
$3,156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$336.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$336.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$311.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$280.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$311.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$280.45
|
| Rate for Payer: University Health Alliance Commercial |
$410.98
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$2,423.89
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$239.12 |
| Max. Negotiated Rate |
$2,060.31 |
| Rate for Payer: AlohaCare Medicaid |
$270.41
|
| Rate for Payer: AlohaCare Medicare |
$239.12
|
| Rate for Payer: Cash Price |
$1,454.33
|
| Rate for Payer: Cash Price |
$1,454.33
|
| Rate for Payer: Devoted Health Medicare |
$263.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$270.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$427.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$270.41
|
| Rate for Payer: Health Management Network Commercial |
$2,060.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$286.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$270.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$270.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.12
|
| Rate for Payer: University Health Alliance Commercial |
$361.67
|
|
|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$1,455.48
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$126.09 |
| Max. Negotiated Rate |
$1,237.16 |
| Rate for Payer: AlohaCare Medicaid |
$144.30
|
| Rate for Payer: AlohaCare Medicare |
$126.09
|
| Rate for Payer: Cash Price |
$873.29
|
| Rate for Payer: Cash Price |
$873.29
|
| Rate for Payer: Devoted Health Medicare |
$138.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.66
|
| Rate for Payer: Health Management Network Commercial |
$1,237.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.09
|
| Rate for Payer: University Health Alliance Commercial |
$194.12
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,073.28
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$232.27 |
| Max. Negotiated Rate |
$1,762.29 |
| Rate for Payer: AlohaCare Medicaid |
$257.36
|
| Rate for Payer: AlohaCare Medicare |
$232.27
|
| Rate for Payer: Cash Price |
$1,243.97
|
| Rate for Payer: Cash Price |
$1,243.97
|
| Rate for Payer: Devoted Health Medicare |
$255.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$257.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$257.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.32
|
| Rate for Payer: Health Management Network Commercial |
$1,762.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$278.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$257.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.27
|
| Rate for Payer: University Health Alliance Commercial |
$344.88
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,514.98
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$1,287.73 |
| Rate for Payer: AlohaCare Medicaid |
$237.01
|
| Rate for Payer: AlohaCare Medicare |
$209.84
|
| Rate for Payer: Cash Price |
$908.99
|
| Rate for Payer: Cash Price |
$908.99
|
| Rate for Payer: Devoted Health Medicare |
$230.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$237.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$378.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$237.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.10
|
| Rate for Payer: Health Management Network Commercial |
$1,287.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$251.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.84
|
| Rate for Payer: University Health Alliance Commercial |
$380.00
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$2,620.78
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$2,227.66 |
| Rate for Payer: AlohaCare Medicaid |
$282.25
|
| Rate for Payer: AlohaCare Medicare |
$248.92
|
| Rate for Payer: Cash Price |
$1,572.47
|
| Rate for Payer: Cash Price |
$1,572.47
|
| Rate for Payer: Devoted Health Medicare |
$273.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$282.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$451.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$282.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$379.60
|
| Rate for Payer: Health Management Network Commercial |
$2,227.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.92
|
| Rate for Payer: University Health Alliance Commercial |
$452.00
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$3,835.40
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$286.36 |
| Max. Negotiated Rate |
$3,260.09 |
| Rate for Payer: AlohaCare Medicaid |
$314.28
|
| Rate for Payer: AlohaCare Medicare |
$286.36
|
| Rate for Payer: Cash Price |
$2,301.24
|
| Rate for Payer: Cash Price |
$2,301.24
|
| Rate for Payer: Devoted Health Medicare |
$315.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$314.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$492.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$314.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.12
|
| Rate for Payer: Health Management Network Commercial |
$3,260.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$343.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$343.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$343.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$314.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.36
|
| Rate for Payer: University Health Alliance Commercial |
$416.56
|
|
|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$2,322.23
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$198.70 |
| Max. Negotiated Rate |
$1,973.90 |
| Rate for Payer: AlohaCare Medicaid |
$223.83
|
| Rate for Payer: AlohaCare Medicare |
$198.70
|
| Rate for Payer: Cash Price |
$1,393.34
|
| Rate for Payer: Cash Price |
$1,393.34
|
| Rate for Payer: Devoted Health Medicare |
$218.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$223.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$356.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$223.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.76
|
| Rate for Payer: Health Management Network Commercial |
$1,973.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.70
|
| Rate for Payer: University Health Alliance Commercial |
$360.00
|
|
|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,065.91
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$183.63 |
| Max. Negotiated Rate |
$1,756.02 |
| Rate for Payer: AlohaCare Medicaid |
$205.09
|
| Rate for Payer: AlohaCare Medicare |
$183.63
|
| Rate for Payer: Cash Price |
$1,239.55
|
| Rate for Payer: Cash Price |
$1,239.55
|
| Rate for Payer: Devoted Health Medicare |
$201.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$205.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$337.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$205.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.24
|
| Rate for Payer: Health Management Network Commercial |
$1,756.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$220.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.63
|
| Rate for Payer: University Health Alliance Commercial |
$275.36
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$211.54
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$179.81 |
| Rate for Payer: AlohaCare Medicaid |
$46.19
|
| Rate for Payer: AlohaCare Medicare |
$40.37
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Devoted Health Medicare |
$44.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$73.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$179.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.37
|
| Rate for Payer: University Health Alliance Commercial |
$65.02
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$442.54
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$376.16 |
| Rate for Payer: AlohaCare Medicaid |
$49.78
|
| Rate for Payer: AlohaCare Medicare |
$44.39
|
| Rate for Payer: Cash Price |
$265.52
|
| Rate for Payer: Cash Price |
$265.52
|
| Rate for Payer: Devoted Health Medicare |
$48.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$376.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.39
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$1,537.71
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$1,307.05 |
| Rate for Payer: AlohaCare Medicaid |
$164.83
|
| Rate for Payer: AlohaCare Medicare |
$144.59
|
| Rate for Payer: Cash Price |
$922.63
|
| Rate for Payer: Cash Price |
$922.63
|
| Rate for Payer: Devoted Health Medicare |
$159.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$164.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$260.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$164.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.36
|
| Rate for Payer: Health Management Network Commercial |
$1,307.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.59
|
| Rate for Payer: University Health Alliance Commercial |
$220.42
|
|
|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$1,515.03
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$1,287.78 |
| Rate for Payer: AlohaCare Medicaid |
$148.27
|
| Rate for Payer: AlohaCare Medicare |
$131.26
|
| Rate for Payer: Cash Price |
$909.02
|
| Rate for Payer: Cash Price |
$909.02
|
| Rate for Payer: Devoted Health Medicare |
$144.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$237.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.12
|
| Rate for Payer: Health Management Network Commercial |
$1,287.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.26
|
| Rate for Payer: University Health Alliance Commercial |
$201.03
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$1,561.37
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$1,327.16 |
| Rate for Payer: AlohaCare Medicaid |
$165.35
|
| Rate for Payer: AlohaCare Medicare |
$147.49
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Devoted Health Medicare |
$162.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$262.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$180.18
|
| Rate for Payer: Health Management Network Commercial |
$1,327.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.49
|
| Rate for Payer: University Health Alliance Commercial |
$221.95
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$3,468.17
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$277.41 |
| Max. Negotiated Rate |
$2,947.94 |
| Rate for Payer: AlohaCare Medicaid |
$308.66
|
| Rate for Payer: AlohaCare Medicare |
$277.41
|
| Rate for Payer: Cash Price |
$2,080.90
|
| Rate for Payer: Cash Price |
$2,080.90
|
| Rate for Payer: Devoted Health Medicare |
$305.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$308.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$481.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$308.66
|
| Rate for Payer: Health Management Network Commercial |
$2,947.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$332.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$277.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$308.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$277.41
|
| Rate for Payer: University Health Alliance Commercial |
$407.86
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$4,439.75
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$3,773.79 |
| Rate for Payer: AlohaCare Medicaid |
$347.57
|
| Rate for Payer: AlohaCare Medicare |
$310.80
|
| Rate for Payer: Cash Price |
$2,663.85
|
| Rate for Payer: Cash Price |
$2,663.85
|
| Rate for Payer: Devoted Health Medicare |
$341.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$347.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$543.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$347.57
|
| Rate for Payer: Health Management Network Commercial |
$3,773.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$347.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$347.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.80
|
| Rate for Payer: University Health Alliance Commercial |
$505.00
|
|
|
PR SLINGS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: AlohaCare Medicaid |
$10.40
|
| Rate for Payer: AlohaCare Medicare |
$10.98
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.55
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.98
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$379.14
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: AlohaCare Medicaid |
$145.39
|
| Rate for Payer: AlohaCare Medicare |
$132.34
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Devoted Health Medicare |
$145.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$221.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.40
|
| Rate for Payer: Health Management Network Commercial |
$322.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.34
|
| Rate for Payer: University Health Alliance Commercial |
$187.22
|
|
