|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: AlohaCare Medicaid |
$561.31
|
| Rate for Payer: AlohaCare Medicare |
$519.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Devoted Health Medicare |
$571.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$519.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$815.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$623.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$561.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$519.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$561.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$519.54
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$293.25
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$167.57 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: AlohaCare Medicaid |
$170.83
|
| Rate for Payer: AlohaCare Medicare |
$167.57
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Devoted Health Medicare |
$184.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.10
|
| Rate for Payer: Health Management Network Commercial |
$249.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.57
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$118.90
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$67.94 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: AlohaCare Medicaid |
$69.44
|
| Rate for Payer: AlohaCare Medicare |
$67.94
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Devoted Health Medicare |
$74.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.92
|
| Rate for Payer: Health Management Network Commercial |
$101.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.94
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$18.95
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: AlohaCare Medicaid |
$11.18
|
| Rate for Payer: AlohaCare Medicare |
$10.83
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Devoted Health Medicare |
$11.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.90
|
| Rate for Payer: Health Management Network Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.83
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$201.92
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$115.38 |
| Max. Negotiated Rate |
$171.63 |
| Rate for Payer: AlohaCare Medicaid |
$118.04
|
| Rate for Payer: AlohaCare Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Devoted Health Medicare |
$126.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.86
|
| Rate for Payer: Health Management Network Commercial |
$171.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.38
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$69.39
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$58.98 |
| Rate for Payer: AlohaCare Medicaid |
$40.86
|
| Rate for Payer: AlohaCare Medicare |
$39.65
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Devoted Health Medicare |
$43.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.62
|
| Rate for Payer: Health Management Network Commercial |
$58.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.65
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$33.23
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Devoted Health Medicare |
$36.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.23
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$70.74
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$77.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.74
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 51784 26
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$37.51
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.51
|
|
|
PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT
|
Professional
|
Both
|
$709.45
|
|
|
Service Code
|
HCPCS 47543
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$1,536.86 |
| Rate for Payer: AlohaCare Medicaid |
$137.78
|
| Rate for Payer: AlohaCare Medicare |
$120.20
|
| Rate for Payer: Cash Price |
$425.67
|
| Rate for Payer: Cash Price |
$425.67
|
| Rate for Payer: Devoted Health Medicare |
$132.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,536.86
|
| Rate for Payer: Health Management Network Commercial |
$603.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.20
|
| Rate for Payer: University Health Alliance Commercial |
$184.79
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$126.19
|
|
|
Service Code
|
HCPCS 92979 26
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: AlohaCare Medicaid |
$138.64
|
| Rate for Payer: AlohaCare Medicare |
$72.11
|
| Rate for Payer: Cash Price |
$75.71
|
| Rate for Payer: Cash Price |
$75.71
|
| Rate for Payer: Devoted Health Medicare |
$79.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.22
|
| Rate for Payer: Health Management Network Commercial |
$107.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.11
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$158.92
|
|
|
Service Code
|
HCPCS 92978 26
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: AlohaCare Medicaid |
$229.41
|
| Rate for Payer: AlohaCare Medicare |
$90.81
|
| Rate for Payer: Cash Price |
$95.35
|
| Rate for Payer: Cash Price |
$95.35
|
| Rate for Payer: Devoted Health Medicare |
$99.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.06
|
| Rate for Payer: Health Management Network Commercial |
$135.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.81
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$91.10
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$77.44 |
| Rate for Payer: AlohaCare Medicaid |
$39.53
|
| Rate for Payer: AlohaCare Medicare |
$34.21
|
| Rate for Payer: Cash Price |
$54.66
|
| Rate for Payer: Cash Price |
$54.66
|
| Rate for Payer: Devoted Health Medicare |
$37.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$77.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.21
|
| Rate for Payer: University Health Alliance Commercial |
$49.26
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$179.10
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$53.35 |
| Max. Negotiated Rate |
$152.24 |
| Rate for Payer: AlohaCare Medicaid |
$62.37
|
| Rate for Payer: AlohaCare Medicare |
$53.35
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Devoted Health Medicare |
$58.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$152.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.35
|
| Rate for Payer: University Health Alliance Commercial |
$76.97
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$144.33
|
| Rate for Payer: AlohaCare Medicare |
$129.11
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$142.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.04
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$154.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.11
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: AlohaCare Medicaid |
$158.80
|
| Rate for Payer: AlohaCare Medicare |
$142.12
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Devoted Health Medicare |
$156.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.72
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.12
|
|
|
PR ENDOVAS NON-CARDIAC ABL CATH
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1888
|
| Min. Negotiated Rate |
$1,336.20 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Health Management Network Commercial |
$1,336.20
|
|
|
PR ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN
|
Professional
|
Both
|
$3,248.61
|
|
|
Service Code
|
HCPCS 36482
|
| Min. Negotiated Rate |
$150.81 |
| Max. Negotiated Rate |
$2,761.32 |
| Rate for Payer: AlohaCare Medicaid |
$169.73
|
| Rate for Payer: AlohaCare Medicare |
$150.81
|
| Rate for Payer: Cash Price |
$1,949.17
|
| Rate for Payer: Cash Price |
$1,949.17
|
| Rate for Payer: Devoted Health Medicare |
$165.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$270.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,446.08
|
| Rate for Payer: Health Management Network Commercial |
$2,761.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.81
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$2,023.88
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$235.18 |
| Max. Negotiated Rate |
$2,263.04 |
| Rate for Payer: AlohaCare Medicaid |
$262.92
|
| Rate for Payer: AlohaCare Medicare |
$235.18
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Devoted Health Medicare |
$258.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$262.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$508.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$235.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$262.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,263.04
|
| Rate for Payer: Health Management Network Commercial |
$1,720.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$282.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$282.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$235.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$262.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$235.18
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Professional
|
Both
|
$516.36
|
|
|
Service Code
|
HCPCS 36476
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$438.91 |
| Rate for Payer: AlohaCare Medicaid |
$125.06
|
| Rate for Payer: AlohaCare Medicare |
$111.25
|
| Rate for Payer: Cash Price |
$309.82
|
| Rate for Payer: Cash Price |
$309.82
|
| Rate for Payer: Devoted Health Medicare |
$122.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$220.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.70
|
| Rate for Payer: Health Management Network Commercial |
$438.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$133.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.25
|
|
|
PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 44121
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$334.90 |
| Rate for Payer: AlohaCare Medicaid |
$230.50
|
| Rate for Payer: AlohaCare Medicare |
$206.33
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Devoted Health Medicare |
$226.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$247.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.33
|
|
|
PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX
|
Professional
|
Both
|
$2,221.00
|
|
|
Service Code
|
HCPCS 44130
|
| Min. Negotiated Rate |
$619.32 |
| Max. Negotiated Rate |
$1,887.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,294.90
|
| Rate for Payer: AlohaCare Medicare |
$1,201.26
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Devoted Health Medicare |
$1,321.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,201.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$619.32
|
| Rate for Payer: Health Management Network Commercial |
$1,887.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,441.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,441.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,441.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,294.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,201.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,294.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,201.26
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 44005
|
| Min. Negotiated Rate |
$852.28 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.82
|
| Rate for Payer: AlohaCare Medicare |
$993.21
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Devoted Health Medicare |
$1,092.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$993.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$852.28
|
| Rate for Payer: Health Management Network Commercial |
$1,560.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,191.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,191.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,191.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,071.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$993.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,071.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$993.21
|
|
|
PR ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
HCPCS 44603
|
| Min. Negotiated Rate |
$680.68 |
| Max. Negotiated Rate |
$2,296.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,579.31
|
| Rate for Payer: AlohaCare Medicare |
$1,437.91
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Devoted Health Medicare |
$1,581.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,437.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$680.68
|
| Rate for Payer: Health Management Network Commercial |
$2,296.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,725.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,725.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,725.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,579.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,437.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,579.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,437.91
|
|
|
PR ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$2,339.00
|
|
|
Service Code
|
HCPCS 44602
|
| Min. Negotiated Rate |
$539.24 |
| Max. Negotiated Rate |
$1,988.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,367.51
|
| Rate for Payer: AlohaCare Medicare |
$1,244.94
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Devoted Health Medicare |
$1,369.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,244.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$539.24
|
| Rate for Payer: Health Management Network Commercial |
$1,988.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,493.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,493.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,493.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,367.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,244.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,367.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,244.94
|
|
