|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$656.49
|
| Rate for Payer: AlohaCare Medicare |
$688.61
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$757.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$688.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$826.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$826.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$826.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$656.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$688.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$656.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$688.61
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicare |
$38.75
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$42.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.25
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.75
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$373.29 |
| Max. Negotiated Rate |
$588.20 |
| Rate for Payer: AlohaCare Medicaid |
$405.37
|
| Rate for Payer: AlohaCare Medicare |
$373.29
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Devoted Health Medicare |
$410.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.29
|
| Rate for Payer: Health Management Network Commercial |
$588.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$447.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$447.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$405.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.29
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$1,051.82 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,140.56
|
| Rate for Payer: AlohaCare Medicare |
$1,051.82
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Devoted Health Medicare |
$1,157.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,051.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,140.62
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,262.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,262.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,262.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,140.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,051.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,140.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,051.82
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$957.03 |
| Max. Negotiated Rate |
$1,507.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,042.60
|
| Rate for Payer: AlohaCare Medicare |
$957.03
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Devoted Health Medicare |
$1,052.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$957.03
|
| Rate for Payer: Health Management Network Commercial |
$1,507.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,148.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,148.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,148.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,042.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$957.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,042.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$957.03
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$1,037.21 |
| Max. Negotiated Rate |
$1,648.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,142.09
|
| Rate for Payer: AlohaCare Medicare |
$1,037.21
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Devoted Health Medicare |
$1,140.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,037.21
|
| Rate for Payer: Health Management Network Commercial |
$1,648.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,244.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,244.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,244.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,142.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,037.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,142.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,037.21
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$1,089.41 |
| Max. Negotiated Rate |
$1,717.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,186.54
|
| Rate for Payer: AlohaCare Medicare |
$1,089.41
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Devoted Health Medicare |
$1,198.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,089.41
|
| Rate for Payer: Health Management Network Commercial |
$1,717.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,307.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,307.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,307.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,186.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,089.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,186.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,089.41
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$1,799.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$969.54 |
| Max. Negotiated Rate |
$1,529.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,056.32
|
| Rate for Payer: AlohaCare Medicare |
$971.97
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: Devoted Health Medicare |
$1,069.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$971.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$969.54
|
| Rate for Payer: Health Management Network Commercial |
$1,529.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,166.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,166.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,166.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,056.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$971.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,056.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$971.97
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$702.04 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: AlohaCare Medicaid |
$762.85
|
| Rate for Payer: AlohaCare Medicare |
$702.04
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Devoted Health Medicare |
$772.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$702.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network Commercial |
$1,105.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$842.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$842.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$842.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$762.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$702.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$762.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$702.04
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$726.44 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: AlohaCare Medicaid |
$911.68
|
| Rate for Payer: AlohaCare Medicare |
$837.74
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Devoted Health Medicare |
$921.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$837.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$726.44
|
| Rate for Payer: Health Management Network Commercial |
$1,319.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,005.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,005.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,005.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$911.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$837.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$911.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$837.74
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$1,739.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,197.78
|
| Rate for Payer: AlohaCare Medicare |
$1,105.36
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Devoted Health Medicare |
$1,215.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,105.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,028.30
|
| Rate for Payer: Health Management Network Commercial |
$1,739.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,326.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,326.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,326.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,197.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,105.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,197.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,105.36
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$1,631.00
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$879.84 |
| Max. Negotiated Rate |
$1,386.35 |
| Rate for Payer: AlohaCare Medicaid |
$957.02
|
| Rate for Payer: AlohaCare Medicare |
$879.84
|
| Rate for Payer: Cash Price |
$978.60
|
| Rate for Payer: Cash Price |
$978.60
|
| Rate for Payer: Devoted Health Medicare |
$967.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$879.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$924.82
|
| Rate for Payer: Health Management Network Commercial |
$1,386.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,055.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,055.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,055.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$957.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$879.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$957.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$879.84
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$1,459.00
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$726.70 |
| Max. Negotiated Rate |
$1,240.15 |
| Rate for Payer: AlohaCare Medicaid |
$846.04
|
| Rate for Payer: AlohaCare Medicare |
$787.97
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Devoted Health Medicare |
$866.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$787.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$726.70
|
| Rate for Payer: Health Management Network Commercial |
$1,240.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$945.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$945.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$945.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$846.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$787.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$846.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$787.97
|
|
|
PR TELEHEALTH FACILITY FEE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS Q3014
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.43
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.00
|
|
|
PR TENDON SHEATH INCISION
|
Professional
|
Both
|
$1,209.58
|
|
|
Service Code
|
HCPCS 26055
|
| Min. Negotiated Rate |
$272.22 |
| Max. Negotiated Rate |
$1,028.14 |
| Rate for Payer: AlohaCare Medicaid |
$316.49
|
| Rate for Payer: AlohaCare Medicare |
$302.31
|
| Rate for Payer: Cash Price |
$725.75
|
| Rate for Payer: Cash Price |
$725.75
|
| Rate for Payer: Devoted Health Medicare |
$332.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$316.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$479.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$302.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$316.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.22
|
| Rate for Payer: Health Management Network Commercial |
$1,028.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$362.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$362.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.31
|
| Rate for Payer: University Health Alliance Commercial |
$406.02
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
HCPCS 23430
|
| Min. Negotiated Rate |
$701.74 |
| Max. Negotiated Rate |
$1,131.35 |
| Rate for Payer: AlohaCare Medicaid |
$775.75
|
| Rate for Payer: AlohaCare Medicare |
$709.33
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Devoted Health Medicare |
$780.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$709.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$701.74
|
| Rate for Payer: Health Management Network Commercial |
$1,131.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$851.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$851.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$851.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$775.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$709.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$775.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$709.33
|
|
|
PR TENODESIS WRIST EXTENSORS FINGERS
|
Professional
|
Both
|
$1,163.00
|
|
|
Service Code
|
HCPCS 25301
|
| Min. Negotiated Rate |
$470.34 |
| Max. Negotiated Rate |
$988.55 |
| Rate for Payer: AlohaCare Medicaid |
$677.05
|
| Rate for Payer: AlohaCare Medicare |
$612.58
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Devoted Health Medicare |
$673.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$612.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$470.34
|
| Rate for Payer: Health Management Network Commercial |
$988.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$735.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$735.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$735.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$677.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$612.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$677.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$612.58
|
|
|
PR TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON
|
Professional
|
Both
|
$1,207.74
|
|
|
Service Code
|
HCPCS 26440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,026.58 |
| Rate for Payer: AlohaCare Medicaid |
$711.95
|
| Rate for Payer: AlohaCare Medicare |
$689.76
|
| Rate for Payer: Cash Price |
$724.64
|
| Rate for Payer: Cash Price |
$724.64
|
| Rate for Payer: Devoted Health Medicare |
$758.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$689.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.00
|
| Rate for Payer: Health Management Network Commercial |
$1,026.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$827.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$827.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$827.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$711.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$689.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$711.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$689.76
|
|
|
PR THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS
|
Professional
|
Both
|
$33.23
|
|
|
Service Code
|
HCPCS 97150
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$28.25 |
| Rate for Payer: AlohaCare Medicaid |
$19.02
|
| Rate for Payer: AlohaCare Medicare |
$18.99
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Devoted Health Medicare |
$20.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.61
|
| Rate for Payer: Health Management Network Commercial |
$28.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.99
|
|
|
PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM
|
Professional
|
Both
|
$28.89
|
|
|
Service Code
|
HCPCS 96372
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$24.56 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$16.51
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Devoted Health Medicare |
$18.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.25
|
| Rate for Payer: Health Management Network Commercial |
$24.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.51
|
|
|
PR THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT
|
Professional
|
Both
|
$517.04
|
|
|
Service Code
|
HCPCS 62329
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$439.48 |
| Rate for Payer: AlohaCare Medicaid |
$102.24
|
| Rate for Payer: AlohaCare Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$310.22
|
| Rate for Payer: Cash Price |
$310.22
|
| Rate for Payer: Devoted Health Medicare |
$98.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$361.66
|
| Rate for Payer: Health Management Network Commercial |
$439.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.99
|
| Rate for Payer: University Health Alliance Commercial |
$127.37
|
|
|
PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 90868
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.54
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
|
|
PR THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 96374
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$62.06 |
| Rate for Payer: AlohaCare Medicaid |
$24.47
|
| Rate for Payer: AlohaCare Medicare |
$41.72
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Devoted Health Medicare |
$45.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.61
|
| Rate for Payer: Health Management Network Commercial |
$62.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.72
|
|
|
PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Professional
|
Both
|
$593.86
|
|
|
Service Code
|
HCPCS 32555
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$504.78 |
| Rate for Payer: AlohaCare Medicaid |
$106.83
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$356.32
|
| Rate for Payer: Cash Price |
$356.32
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.83
|
| Rate for Payer: Health Management Network Commercial |
$504.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$132.55
|
|
|
PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Professional
|
Both
|
$497.37
|
|
|
Service Code
|
HCPCS 32554
|
| Min. Negotiated Rate |
$77.99 |
| Max. Negotiated Rate |
$422.76 |
| Rate for Payer: AlohaCare Medicaid |
$86.69
|
| Rate for Payer: AlohaCare Medicare |
$77.99
|
| Rate for Payer: Cash Price |
$298.42
|
| Rate for Payer: Cash Price |
$298.42
|
| Rate for Payer: Devoted Health Medicare |
$85.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.69
|
| Rate for Payer: Health Management Network Commercial |
$422.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.99
|
| Rate for Payer: University Health Alliance Commercial |
$116.87
|
|
