|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$305.27
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$259.48 |
| Rate for Payer: AlohaCare Medicaid |
$66.42
|
| Rate for Payer: AlohaCare Medicare |
$58.99
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Devoted Health Medicare |
$64.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.34
|
| Rate for Payer: Health Management Network Commercial |
$259.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.99
|
| Rate for Payer: University Health Alliance Commercial |
$78.39
|
|
|
PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 19083
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: AlohaCare Medicaid |
$151.43
|
| Rate for Payer: AlohaCare Medicare |
$128.33
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Devoted Health Medicare |
$141.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$242.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$755.30
|
| Rate for Payer: Health Management Network Commercial |
$774.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$154.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.33
|
| Rate for Payer: University Health Alliance Commercial |
$200.00
|
|
|
PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Professional
|
Both
|
$320.98
|
|
|
Service Code
|
HCPCS 38505
|
| Min. Negotiated Rate |
$74.81 |
| Max. Negotiated Rate |
$272.83 |
| Rate for Payer: AlohaCare Medicaid |
$85.75
|
| Rate for Payer: AlohaCare Medicare |
$74.81
|
| Rate for Payer: Cash Price |
$192.59
|
| Rate for Payer: Cash Price |
$192.59
|
| Rate for Payer: Devoted Health Medicare |
$82.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$85.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$130.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$85.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$272.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.81
|
| Rate for Payer: University Health Alliance Commercial |
$106.77
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$651.10 |
| Rate for Payer: AlohaCare Medicaid |
$446.82
|
| Rate for Payer: AlohaCare Medicare |
$430.82
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Devoted Health Medicare |
$473.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$430.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.78
|
| Rate for Payer: Health Management Network Commercial |
$651.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$516.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$516.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$516.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$446.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$446.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$430.82
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,002.54
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$852.16 |
| Rate for Payer: AlohaCare Medicaid |
$422.47
|
| Rate for Payer: AlohaCare Medicare |
$376.16
|
| Rate for Payer: Cash Price |
$601.52
|
| Rate for Payer: Cash Price |
$601.52
|
| Rate for Payer: Devoted Health Medicare |
$413.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$422.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$659.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$422.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$852.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.16
|
| Rate for Payer: University Health Alliance Commercial |
$557.99
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$676.06
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$574.65 |
| Rate for Payer: AlohaCare Medicaid |
$258.09
|
| Rate for Payer: AlohaCare Medicare |
$245.42
|
| Rate for Payer: Cash Price |
$405.64
|
| Rate for Payer: Cash Price |
$405.64
|
| Rate for Payer: Devoted Health Medicare |
$269.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$258.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$403.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$258.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$574.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$258.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$258.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.42
|
| Rate for Payer: University Health Alliance Commercial |
$341.82
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: AlohaCare Medicare |
$87.97
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Devoted Health Medicare |
$96.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.42
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.97
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$458.60
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$389.81 |
| Rate for Payer: AlohaCare Medicaid |
$151.68
|
| Rate for Payer: AlohaCare Medicare |
$134.83
|
| Rate for Payer: Cash Price |
$275.16
|
| Rate for Payer: Cash Price |
$275.16
|
| Rate for Payer: Devoted Health Medicare |
$148.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.32
|
| Rate for Payer: Health Management Network Commercial |
$389.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.83
|
| Rate for Payer: University Health Alliance Commercial |
$194.72
|
|
|
PR BX PROSTATE IN-BORE CT/MRI TRGT LES ONLY 1ST
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 55714
|
| Min. Negotiated Rate |
$167.02 |
| Max. Negotiated Rate |
$969.85 |
| Rate for Payer: AlohaCare Medicare |
$167.02
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Devoted Health Medicare |
$183.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.02
|
| Rate for Payer: Health Management Network Commercial |
$969.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.02
|
|
|
PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$561.85 |
| Rate for Payer: AlohaCare Medicaid |
$384.84
|
| Rate for Payer: AlohaCare Medicare |
$202.37
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$222.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.37
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$384.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.37
|
|
|
PR BX PROSTATE TPRNL MRI-US GID TRGT LES 1ST
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 55712
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: AlohaCare Medicare |
$157.80
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Devoted Health Medicare |
$173.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.80
|
| Rate for Payer: Health Management Network Commercial |
$994.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$189.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.80
|
|
|
PR BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 55709
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$951.15 |
| Rate for Payer: AlohaCare Medicare |
$162.72
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Devoted Health Medicare |
$178.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.72
|
| Rate for Payer: Health Management Network Commercial |
$951.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$195.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.72
|
|
|
PR BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 55710
|
| Min. Negotiated Rate |
$187.81 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: AlohaCare Medicare |
$187.81
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Devoted Health Medicare |
$206.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.81
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.81
|
|
|
PR BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST
|
Professional
|
Both
|
$699.00
|
|
|
Service Code
|
HCPCS 55711
|
| Min. Negotiated Rate |
$135.72 |
| Max. Negotiated Rate |
$594.15 |
| Rate for Payer: AlohaCare Medicare |
$135.72
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Devoted Health Medicare |
$149.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.72
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.72
|
|
|
PR BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 55708
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: AlohaCare Medicare |
$169.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Devoted Health Medicare |
$186.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.40
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$203.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.40
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$3,118.00
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,693.59 |
| Max. Negotiated Rate |
$2,650.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,833.53
|
| Rate for Payer: AlohaCare Medicare |
$1,693.59
|
| Rate for Payer: Cash Price |
$1,870.80
|
| Rate for Payer: Cash Price |
$1,870.80
|
| Rate for Payer: Devoted Health Medicare |
$1,862.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,693.59
|
| Rate for Payer: Health Management Network Commercial |
$2,650.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,032.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,032.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,032.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,833.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,693.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,833.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,693.59
|
|
|
PR BYPASS W/VEIN AORTOFEMORAL
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 35539
|
| Min. Negotiated Rate |
$1,859.13 |
| Max. Negotiated Rate |
$2,927.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,018.14
|
| Rate for Payer: AlohaCare Medicare |
$1,859.13
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Devoted Health Medicare |
$2,045.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,859.13
|
| Rate for Payer: Health Management Network Commercial |
$2,927.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,230.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,230.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,230.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,018.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,859.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,018.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,859.13
|
|
|
PR BYPASS W/VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 35521
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,139.59
|
| Rate for Payer: AlohaCare Medicare |
$1,052.35
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Devoted Health Medicare |
$1,157.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,052.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$982.80
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,262.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,262.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,262.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,139.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,052.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,139.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,052.35
|
|
|
PR BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,379.00
|
|
|
Service Code
|
HCPCS 35533
|
| Min. Negotiated Rate |
$1,216.54 |
| Max. Negotiated Rate |
$2,022.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,394.01
|
| Rate for Payer: AlohaCare Medicare |
$1,285.10
|
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Devoted Health Medicare |
$1,413.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,285.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,216.54
|
| Rate for Payer: Health Management Network Commercial |
$2,022.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,542.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,542.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,542.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,394.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,285.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,394.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,285.10
|
|
|
PR BYPASS W/VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 35501
|
| Min. Negotiated Rate |
$1,113.32 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,347.54
|
| Rate for Payer: AlohaCare Medicare |
$1,243.74
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,379.40
|
| Rate for Payer: Devoted Health Medicare |
$1,368.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,243.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,113.32
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,492.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,492.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,492.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,347.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,243.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,347.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,243.74
|
|
|
PR BYPASS W/VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,211.00
|
|
|
Service Code
|
HCPCS 35556
|
| Min. Negotiated Rate |
$1,181.18 |
| Max. Negotiated Rate |
$1,879.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,296.52
|
| Rate for Payer: AlohaCare Medicare |
$1,192.04
|
| Rate for Payer: Cash Price |
$1,326.60
|
| Rate for Payer: Cash Price |
$1,326.60
|
| Rate for Payer: Devoted Health Medicare |
$1,311.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,192.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,181.18
|
| Rate for Payer: Health Management Network Commercial |
$1,879.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,430.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,430.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,430.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,192.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,296.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,192.04
|
|
|
PR BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL
|
Professional
|
Both
|
$2,624.00
|
|
|
Service Code
|
HCPCS 35566
|
| Min. Negotiated Rate |
$1,400.62 |
| Max. Negotiated Rate |
$2,230.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,541.00
|
| Rate for Payer: AlohaCare Medicare |
$1,412.89
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Devoted Health Medicare |
$1,554.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,412.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,400.62
|
| Rate for Payer: Health Management Network Commercial |
$2,230.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,695.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,695.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,695.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,541.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,412.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,541.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,412.89
|
|
|
PR BYP OTH/THN VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 35646
|
| Min. Negotiated Rate |
$1,447.42 |
| Max. Negotiated Rate |
$2,292.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,584.29
|
| Rate for Payer: AlohaCare Medicare |
$1,455.10
|
| Rate for Payer: Cash Price |
$1,618.20
|
| Rate for Payer: Cash Price |
$1,618.20
|
| Rate for Payer: Devoted Health Medicare |
$1,600.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,455.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,447.42
|
| Rate for Payer: Health Management Network Commercial |
$2,292.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,746.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,746.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,746.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,584.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,455.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,584.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,455.10
|
|
|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$875.27 |
| Max. Negotiated Rate |
$1,374.45 |
| Rate for Payer: AlohaCare Medicaid |
$947.07
|
| Rate for Payer: AlohaCare Medicare |
$875.27
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Devoted Health Medicare |
$962.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$875.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$887.38
|
| Rate for Payer: Health Management Network Commercial |
$1,374.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,050.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,050.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,050.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$947.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$875.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$947.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$875.27
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$904.28 |
| Max. Negotiated Rate |
$1,477.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,021.65
|
| Rate for Payer: AlohaCare Medicare |
$934.92
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Devoted Health Medicare |
$1,028.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$934.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$904.28
|
| Rate for Payer: Health Management Network Commercial |
$1,477.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,121.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,121.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,121.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,021.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$934.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,021.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$934.92
|
|
