|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: AlohaCare Medicaid |
$3.11
|
| Rate for Payer: AlohaCare Medicare |
$7.76
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$8.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.02
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.76
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: AlohaCare Medicaid |
$13.27
|
| Rate for Payer: AlohaCare Medicare |
$23.79
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Devoted Health Medicare |
$26.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.45
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.79
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AlohaCare Medicare |
$11.90
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$13.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.23
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.90
|
|
|
PR CAST SUP SHT LEG SPLNT PED P
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: AlohaCare Medicaid |
$4.12
|
| Rate for Payer: AlohaCare Medicare |
$7.36
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.72
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.36
|
|
|
PR CAST SUP SHT LEG SPLNT PLSTR
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4045
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: AlohaCare Medicaid |
$5.94
|
| Rate for Payer: AlohaCare Medicare |
$14.79
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Devoted Health Medicare |
$16.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.47
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.79
|
|
|
PR CATHETERIZE FOR URINE SPEC
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS P9612
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$51.15 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$9.34
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$10.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.15
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.34
|
|
|
PR CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$160.70
|
|
|
Service Code
|
HCPCS 36510
|
| Min. Negotiated Rate |
$45.11 |
| Max. Negotiated Rate |
$136.59 |
| Rate for Payer: AlohaCare Medicaid |
$53.08
|
| Rate for Payer: AlohaCare Medicare |
$45.11
|
| Rate for Payer: Cash Price |
$96.42
|
| Rate for Payer: Cash Price |
$96.42
|
| Rate for Payer: Devoted Health Medicare |
$49.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.64
|
| Rate for Payer: Health Management Network Commercial |
$136.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.11
|
| Rate for Payer: University Health Alliance Commercial |
$70.85
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$2,748.00
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$960.61 |
| Max. Negotiated Rate |
$2,335.80 |
| Rate for Payer: AlohaCare Medicaid |
$982.40
|
| Rate for Payer: AlohaCare Medicare |
$960.61
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Devoted Health Medicare |
$1,056.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$960.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,029.16
|
| Rate for Payer: Health Management Network Commercial |
$2,335.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,152.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,152.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,152.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$982.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$960.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$982.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$960.61
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93454 26
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,029.16 |
| Rate for Payer: AlohaCare Medicaid |
$982.40
|
| Rate for Payer: AlohaCare Medicare |
$228.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Devoted Health Medicare |
$251.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,029.16
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$274.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$274.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$982.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$982.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.59
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$2,348.00
|
|
|
Service Code
|
HCPCS 93454 TC
|
| Min. Negotiated Rate |
$732.02 |
| Max. Negotiated Rate |
$1,995.80 |
| Rate for Payer: AlohaCare Medicaid |
$982.40
|
| Rate for Payer: AlohaCare Medicare |
$732.02
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Devoted Health Medicare |
$805.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$732.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,029.16
|
| Rate for Payer: Health Management Network Commercial |
$1,995.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$878.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$878.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$878.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$982.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$732.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$982.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$732.02
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 93459 26
|
| Min. Negotiated Rate |
$319.40 |
| Max. Negotiated Rate |
$1,209.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,209.25
|
| Rate for Payer: AlohaCare Medicare |
$319.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Devoted Health Medicare |
$351.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.40
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$383.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$383.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$383.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$319.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,209.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.40
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,332.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$1,184.16 |
| Max. Negotiated Rate |
$2,832.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,209.25
|
| Rate for Payer: AlohaCare Medicare |
$1,184.16
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Devoted Health Medicare |
$1,302.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,184.16
|
| Rate for Payer: Health Management Network Commercial |
$2,832.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,420.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,420.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,420.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,184.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,209.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,184.16
|
|
|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,773.00
|
|
|
Service Code
|
HCPCS 93459 TC
|
| Min. Negotiated Rate |
$864.75 |
| Max. Negotiated Rate |
$2,357.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,209.25
|
| Rate for Payer: AlohaCare Medicare |
$864.75
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Devoted Health Medicare |
$951.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$864.75
|
| Rate for Payer: Health Management Network Commercial |
$2,357.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,037.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,037.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,037.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$864.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,209.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$864.75
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,127.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$1,094.21 |
| Max. Negotiated Rate |
$2,657.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,126.79
|
| Rate for Payer: AlohaCare Medicare |
$1,102.37
|
| Rate for Payer: Cash Price |
$1,876.20
|
| Rate for Payer: Cash Price |
$1,876.20
|
| Rate for Payer: Devoted Health Medicare |
$1,212.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,102.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,094.21
|
| Rate for Payer: Health Management Network Commercial |
$2,657.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,322.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,322.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,322.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,126.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,102.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,126.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,102.37
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 93458 TC
|
| Min. Negotiated Rate |
$820.89 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,126.79
|
| Rate for Payer: AlohaCare Medicare |
$820.89
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Devoted Health Medicare |
$902.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$820.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,094.21
|
| Rate for Payer: Health Management Network Commercial |
$2,238.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$985.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$985.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$985.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,126.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$820.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,126.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$820.89
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 93458 26
|
| Min. Negotiated Rate |
$281.49 |
| Max. Negotiated Rate |
$1,126.79 |
| Rate for Payer: AlohaCare Medicaid |
$1,126.79
|
| Rate for Payer: AlohaCare Medicare |
$281.49
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Devoted Health Medicare |
$309.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,094.21
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$337.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,126.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,126.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.49
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
HCPCS 93455 TC
|
| Min. Negotiated Rate |
$803.42 |
| Max. Negotiated Rate |
$2,191.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$803.42
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Devoted Health Medicare |
$883.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$803.42
|
| Rate for Payer: Health Management Network Commercial |
$2,191.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$964.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$964.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$964.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$803.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$803.42
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 93455 26
|
| Min. Negotiated Rate |
$266.32 |
| Max. Negotiated Rate |
$1,092.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$266.32
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Devoted Health Medicare |
$292.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.32
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.32
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$3,044.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$1,069.74 |
| Max. Negotiated Rate |
$2,587.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$1,069.74
|
| Rate for Payer: Cash Price |
$1,826.40
|
| Rate for Payer: Cash Price |
$1,826.40
|
| Rate for Payer: Devoted Health Medicare |
$1,176.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,069.74
|
| Rate for Payer: Health Management Network Commercial |
$2,587.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,283.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,283.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,283.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,069.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,069.74
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 93457 TC
|
| Min. Negotiated Rate |
$968.05 |
| Max. Negotiated Rate |
$2,632.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$968.05
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Devoted Health Medicare |
$1,064.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$968.05
|
| Rate for Payer: Health Management Network Commercial |
$2,632.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,161.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,161.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,161.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$968.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$968.05
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 93457 26
|
| Min. Negotiated Rate |
$334.47 |
| Max. Negotiated Rate |
$1,328.27 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$334.47
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.47
|
| Rate for Payer: Health Management Network Commercial |
$497.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$401.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$401.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.47
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$3,682.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$1,302.52 |
| Max. Negotiated Rate |
$3,129.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$1,302.52
|
| Rate for Payer: Cash Price |
$2,209.20
|
| Rate for Payer: Cash Price |
$2,209.20
|
| Rate for Payer: Devoted Health Medicare |
$1,432.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,302.52
|
| Rate for Payer: Health Management Network Commercial |
$3,129.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,563.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,563.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,563.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,302.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,302.52
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,393.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$1,195.43 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$1,195.43
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Devoted Health Medicare |
$1,314.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,195.43
|
| Rate for Payer: Health Management Network Commercial |
$2,884.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,434.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,434.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,434.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,195.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,195.43
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 93456 26
|
| Min. Negotiated Rate |
$297.45 |
| Max. Negotiated Rate |
$1,220.13 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$297.45
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$327.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.45
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.45
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,872.00
|
|
|
Service Code
|
HCPCS 93456 TC
|
| Min. Negotiated Rate |
$897.98 |
| Max. Negotiated Rate |
$2,441.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$897.98
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Devoted Health Medicare |
$987.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$897.98
|
| Rate for Payer: Health Management Network Commercial |
$2,441.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,077.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,077.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.98
|
|
