|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$1,147.64 |
| Max. Negotiated Rate |
$1,843.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,268.49
|
| Rate for Payer: AlohaCare Medicare |
$1,167.15
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Devoted Health Medicare |
$1,283.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,167.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,147.64
|
| Rate for Payer: Health Management Network Commercial |
$1,843.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,400.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,400.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,400.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,268.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,167.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,268.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,167.15
|
|
|
PR BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL
|
Professional
|
Both
|
$2,081.00
|
|
|
Service Code
|
HCPCS 35623
|
| Min. Negotiated Rate |
$731.64 |
| Max. Negotiated Rate |
$1,768.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.10
|
| Rate for Payer: AlohaCare Medicare |
$1,123.72
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Devoted Health Medicare |
$1,236.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,123.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$731.64
|
| Rate for Payer: Health Management Network Commercial |
$1,768.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,348.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,348.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,348.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,218.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,123.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,218.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,123.72
|
|
|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$1,006.68 |
| Max. Negotiated Rate |
$1,586.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,097.20
|
| Rate for Payer: AlohaCare Medicare |
$1,006.68
|
| Rate for Payer: Cash Price |
$1,120.20
|
| Rate for Payer: Cash Price |
$1,120.20
|
| Rate for Payer: Devoted Health Medicare |
$1,107.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,006.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,055.60
|
| Rate for Payer: Health Management Network Commercial |
$1,586.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,208.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,208.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,208.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,097.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,006.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,097.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,006.68
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$1,112.33 |
| Max. Negotiated Rate |
$1,747.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,209.87
|
| Rate for Payer: AlohaCare Medicare |
$1,112.33
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Devoted Health Medicare |
$1,223.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,112.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,160.12
|
| Rate for Payer: Health Management Network Commercial |
$1,747.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,334.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,334.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,334.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,112.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,209.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,112.33
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$1,728.00
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,013.24
|
| Rate for Payer: AlohaCare Medicare |
$932.18
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Devoted Health Medicare |
$1,025.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$932.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,468.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,118.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,118.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,118.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,013.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$932.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,013.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$932.18
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$1,702.00
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$919.30 |
| Max. Negotiated Rate |
$1,446.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,000.01
|
| Rate for Payer: AlohaCare Medicare |
$919.30
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Devoted Health Medicare |
$1,011.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$919.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,085.76
|
| Rate for Payer: Health Management Network Commercial |
$1,446.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,103.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,103.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,103.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$919.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,000.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$919.30
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$952.12 |
| Max. Negotiated Rate |
$1,585.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,096.83
|
| Rate for Payer: AlohaCare Medicare |
$1,009.82
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Devoted Health Medicare |
$1,110.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,009.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$952.12
|
| Rate for Payer: Health Management Network Commercial |
$1,585.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,211.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,211.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,211.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,096.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,009.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,096.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,009.82
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$921.18 |
| Max. Negotiated Rate |
$1,533.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,065.99
|
| Rate for Payer: AlohaCare Medicare |
$980.85
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Devoted Health Medicare |
$1,078.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$980.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$921.18
|
| Rate for Payer: Health Management Network Commercial |
$1,533.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,177.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,177.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,065.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$980.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,065.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$980.85
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$1,258.66 |
| Max. Negotiated Rate |
$1,979.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,364.45
|
| Rate for Payer: AlohaCare Medicare |
$1,258.66
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Devoted Health Medicare |
$1,384.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,258.66
|
| Rate for Payer: Health Management Network Commercial |
$1,979.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,510.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,510.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,510.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,364.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,258.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,364.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,258.66
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$1,132.32 |
| Max. Negotiated Rate |
$1,783.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,230.65
|
| Rate for Payer: AlohaCare Medicare |
$1,132.32
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Devoted Health Medicare |
$1,245.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,132.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,469.52
|
| Rate for Payer: Health Management Network Commercial |
$1,783.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,358.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,358.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,358.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,230.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,132.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,230.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,132.32
|
|
|
PR CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$74.58
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$63.39 |
| Rate for Payer: AlohaCare Medicaid |
$36.24
|
| Rate for Payer: AlohaCare Medicare |
$30.09
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Devoted Health Medicare |
$33.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.96
|
| Rate for Payer: Health Management Network Commercial |
$63.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.09
|
| Rate for Payer: University Health Alliance Commercial |
$44.34
|
|
|
PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 27036
|
| Min. Negotiated Rate |
$738.92 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,049.92
|
| Rate for Payer: AlohaCare Medicare |
$952.58
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Devoted Health Medicare |
$1,047.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$952.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.92
|
| Rate for Payer: Health Management Network Commercial |
$1,532.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,143.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,143.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,143.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,049.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$952.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,049.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$952.58
|
|
|
PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$1,794.00
|
|
|
Service Code
|
HCPCS 25320
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,041.79
|
| Rate for Payer: AlohaCare Medicare |
$952.82
|
| Rate for Payer: Cash Price |
$1,076.40
|
| Rate for Payer: Cash Price |
$1,076.40
|
| Rate for Payer: Devoted Health Medicare |
$1,048.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$952.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$597.48
|
| Rate for Payer: Health Management Network Commercial |
$1,524.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,143.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,143.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,143.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,041.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$952.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,041.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$952.82
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 26516
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$1,156.85 |
| Rate for Payer: AlohaCare Medicaid |
$801.26
|
| Rate for Payer: AlohaCare Medicare |
$757.54
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Devoted Health Medicare |
$833.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$757.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$388.96
|
| Rate for Payer: Health Management Network Commercial |
$1,156.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$909.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$909.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$909.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$801.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$757.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$801.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$757.54
|
|
|
PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 23450
|
| Min. Negotiated Rate |
$786.76 |
| Max. Negotiated Rate |
$1,416.95 |
| Rate for Payer: AlohaCare Medicaid |
$971.31
|
| Rate for Payer: AlohaCare Medicare |
$876.94
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Devoted Health Medicare |
$964.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$876.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$786.76
|
| Rate for Payer: Health Management Network Commercial |
$1,416.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,052.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,052.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$971.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$876.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$971.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$876.94
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$1,873.00
|
|
|
Service Code
|
HCPCS 23462
|
| Min. Negotiated Rate |
$908.96 |
| Max. Negotiated Rate |
$1,592.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,091.51
|
| Rate for Payer: AlohaCare Medicare |
$980.29
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Devoted Health Medicare |
$1,078.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$980.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$908.96
|
| Rate for Payer: Health Management Network Commercial |
$1,592.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,176.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,176.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,176.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,091.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$980.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,091.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$980.29
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$884.75 |
| Max. Negotiated Rate |
$1,452.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,010.44
|
| Rate for Payer: AlohaCare Medicare |
$884.75
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Devoted Health Medicare |
$973.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$884.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,174.16
|
| Rate for Payer: Health Management Network Commercial |
$1,452.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,061.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,061.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,061.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,010.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$884.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,010.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$884.75
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$708.73
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$167.64 |
| Max. Negotiated Rate |
$602.42 |
| Rate for Payer: AlohaCare Medicaid |
$179.25
|
| Rate for Payer: AlohaCare Medicare |
$167.64
|
| Rate for Payer: Cash Price |
$425.24
|
| Rate for Payer: Cash Price |
$425.24
|
| Rate for Payer: Devoted Health Medicare |
$184.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$179.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$179.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.90
|
| Rate for Payer: Health Management Network Commercial |
$602.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$179.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.64
|
| Rate for Payer: University Health Alliance Commercial |
$218.44
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$287.19
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$244.11 |
| Rate for Payer: AlohaCare Medicaid |
$108.77
|
| Rate for Payer: AlohaCare Medicare |
$96.14
|
| Rate for Payer: Cash Price |
$172.31
|
| Rate for Payer: Cash Price |
$172.31
|
| Rate for Payer: Devoted Health Medicare |
$105.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network Commercial |
$244.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.14
|
| Rate for Payer: University Health Alliance Commercial |
$135.15
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$207.33 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: AlohaCare Medicaid |
$233.54
|
| Rate for Payer: AlohaCare Medicare |
$207.33
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Devoted Health Medicare |
$228.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.33
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.33
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$345.54 |
| Max. Negotiated Rate |
$769.25 |
| Rate for Payer: AlohaCare Medicaid |
$525.81
|
| Rate for Payer: AlohaCare Medicare |
$482.54
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Devoted Health Medicare |
$530.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$345.54
|
| Rate for Payer: Health Management Network Commercial |
$769.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.54
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$525.72 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: AlohaCare Medicaid |
$653.51
|
| Rate for Payer: AlohaCare Medicare |
$592.52
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Devoted Health Medicare |
$651.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.72
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$711.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$711.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.52
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 94780
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: AlohaCare Medicaid |
$23.42
|
| Rate for Payer: AlohaCare Medicare |
$20.41
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$22.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.42
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.41
|
| Rate for Payer: University Health Alliance Commercial |
$28.80
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 94781
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: AlohaCare Medicaid |
$8.14
|
| Rate for Payer: AlohaCare Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$7.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.14
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.01
|
| Rate for Payer: University Health Alliance Commercial |
$9.92
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$441.22 |
| Max. Negotiated Rate |
$735.25 |
| Rate for Payer: AlohaCare Medicaid |
$506.58
|
| Rate for Payer: AlohaCare Medicare |
$447.01
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Devoted Health Medicare |
$491.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$441.22
|
| Rate for Payer: Health Management Network Commercial |
$735.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$536.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$536.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$536.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.01
|
|
