|
PR INPT/ED TELECONSULT30
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$83.37 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.13
|
| Rate for Payer: AlohaCare Medicare |
$83.37
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Devoted Health Medicare |
$91.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.37
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.37
|
|
|
PR INPT/ED TELECONSULT50
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$117.07 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: AlohaCare Medicaid |
$131.34
|
| Rate for Payer: AlohaCare Medicare |
$117.07
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Devoted Health Medicare |
$128.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.07
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.07
|
|
|
PR INPT/ED TELECONSULT70
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: AlohaCare Medicaid |
$186.13
|
| Rate for Payer: AlohaCare Medicare |
$168.52
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Devoted Health Medicare |
$185.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.52
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.52
|
|
|
PR INPT/TELE FOLLOW UP 15
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS G0406
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: AlohaCare Medicaid |
$41.51
|
| Rate for Payer: AlohaCare Medicare |
$36.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Devoted Health Medicare |
$39.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.05
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.05
|
|
|
PR INPT/TELE FOLLOW UP 25
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: AlohaCare Medicaid |
$72.61
|
| Rate for Payer: AlohaCare Medicare |
$63.94
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Devoted Health Medicare |
$70.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.94
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.94
|
|
|
PR INPT/TELE FOLLOW UP 35
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$93.83 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: AlohaCare Medicaid |
$105.89
|
| Rate for Payer: AlohaCare Medicare |
$93.83
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$103.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.83
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.83
|
|
|
PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,895.44
|
|
|
Service Code
|
HCPCS 49441
|
| Min. Negotiated Rate |
$213.82 |
| Max. Negotiated Rate |
$1,611.12 |
| Rate for Payer: AlohaCare Medicaid |
$235.46
|
| Rate for Payer: AlohaCare Medicare |
$213.82
|
| Rate for Payer: Cash Price |
$1,137.26
|
| Rate for Payer: Cash Price |
$1,137.26
|
| Rate for Payer: Devoted Health Medicare |
$235.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$235.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$367.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$235.46
|
| Rate for Payer: Health Management Network Commercial |
$1,611.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$235.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.82
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$1,525.07
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$177.26 |
| Max. Negotiated Rate |
$1,296.31 |
| Rate for Payer: AlohaCare Medicaid |
$199.29
|
| Rate for Payer: AlohaCare Medicare |
$177.26
|
| Rate for Payer: Cash Price |
$915.04
|
| Rate for Payer: Cash Price |
$915.04
|
| Rate for Payer: Devoted Health Medicare |
$194.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,100.32
|
| Rate for Payer: Health Management Network Commercial |
$1,296.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.26
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$400.14 |
| Max. Negotiated Rate |
$1,143.25 |
| Rate for Payer: AlohaCare Medicaid |
$782.42
|
| Rate for Payer: AlohaCare Medicare |
$712.91
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Devoted Health Medicare |
$784.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$712.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$400.14
|
| Rate for Payer: Health Management Network Commercial |
$1,143.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$855.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$855.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$855.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$782.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$712.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$782.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$712.91
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$198.26
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$168.52 |
| Rate for Payer: AlohaCare Medicaid |
$61.76
|
| Rate for Payer: AlohaCare Medicare |
$53.29
|
| Rate for Payer: Cash Price |
$118.96
|
| Rate for Payer: Cash Price |
$118.96
|
| Rate for Payer: Devoted Health Medicare |
$58.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$168.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.29
|
| Rate for Payer: University Health Alliance Commercial |
$67.44
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$191.50 |
| Rate for Payer: AlohaCare Medicaid |
$84.85
|
| Rate for Payer: AlohaCare Medicare |
$80.39
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$88.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.39
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$1,513.24
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$179.23 |
| Max. Negotiated Rate |
$1,286.25 |
| Rate for Payer: AlohaCare Medicaid |
$199.47
|
| Rate for Payer: AlohaCare Medicare |
$179.23
|
| Rate for Payer: Cash Price |
$907.94
|
| Rate for Payer: Cash Price |
$907.94
|
| Rate for Payer: Devoted Health Medicare |
$197.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$315.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.47
|
| Rate for Payer: Health Management Network Commercial |
$1,286.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$215.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.23
|
| Rate for Payer: University Health Alliance Commercial |
$247.60
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$213.67 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: AlohaCare Medicaid |
$243.80
|
| Rate for Payer: AlohaCare Medicare |
$213.67
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Devoted Health Medicare |
$235.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.96
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.67
|
|
|
PR INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 58300
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.40
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.02
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.40
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$332.02 |
| Rate for Payer: AlohaCare Medicaid |
$87.91
|
| Rate for Payer: AlohaCare Medicare |
$81.05
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$89.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.02
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.05
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$83.36 |
| Max. Negotiated Rate |
$355.42 |
| Rate for Payer: AlohaCare Medicaid |
$91.61
|
| Rate for Payer: AlohaCare Medicare |
$83.36
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Devoted Health Medicare |
$91.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$134.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$355.42
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.36
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$709.24
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$71.08 |
| Max. Negotiated Rate |
$602.85 |
| Rate for Payer: AlohaCare Medicaid |
$81.56
|
| Rate for Payer: AlohaCare Medicare |
$71.08
|
| Rate for Payer: Cash Price |
$425.54
|
| Rate for Payer: Cash Price |
$425.54
|
| Rate for Payer: Devoted Health Medicare |
$78.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.92
|
| Rate for Payer: Health Management Network Commercial |
$602.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.08
|
| Rate for Payer: University Health Alliance Commercial |
$109.52
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$7,966.75
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$6,771.74 |
| Rate for Payer: AlohaCare Medicaid |
$83.86
|
| Rate for Payer: AlohaCare Medicare |
$72.68
|
| Rate for Payer: Cash Price |
$4,780.05
|
| Rate for Payer: Cash Price |
$4,780.05
|
| Rate for Payer: Devoted Health Medicare |
$79.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$134.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.04
|
| Rate for Payer: Health Management Network Commercial |
$6,771.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.68
|
| Rate for Payer: University Health Alliance Commercial |
$113.67
|
|
|
PR INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 11960
|
| Min. Negotiated Rate |
$684.84 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,073.46
|
| Rate for Payer: AlohaCare Medicare |
$990.01
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Devoted Health Medicare |
$1,089.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$990.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$684.84
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,188.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,188.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,073.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$990.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,073.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$990.01
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: AlohaCare Medicaid |
$216.75
|
| Rate for Payer: AlohaCare Medicare |
$197.12
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Devoted Health Medicare |
$216.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.38
|
| Rate for Payer: Health Management Network Commercial |
$315.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.12
|
|
|
PR INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$466.29
|
|
|
Service Code
|
HCPCS 20650
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$396.35 |
| Rate for Payer: AlohaCare Medicaid |
$174.98
|
| Rate for Payer: AlohaCare Medicare |
$164.67
|
| Rate for Payer: Cash Price |
$279.77
|
| Rate for Payer: Cash Price |
$279.77
|
| Rate for Payer: Devoted Health Medicare |
$181.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$396.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$197.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.67
|
| Rate for Payer: University Health Alliance Commercial |
$218.80
|
|
|
PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Professional
|
Both
|
$3,697.92
|
|
|
Service Code
|
HCPCS 37191
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$3,143.23 |
| Rate for Payer: AlohaCare Medicaid |
$211.10
|
| Rate for Payer: AlohaCare Medicare |
$185.39
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Devoted Health Medicare |
$203.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$211.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$336.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$185.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.10
|
| Rate for Payer: Health Management Network Commercial |
$3,143.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$222.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$185.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$185.39
|
| Rate for Payer: University Health Alliance Commercial |
$337.00
|
|
|
PR IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART
|
Professional
|
Both
|
$2,641.00
|
|
|
Service Code
|
HCPCS 35585
|
| Min. Negotiated Rate |
$1,420.11 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,549.79
|
| Rate for Payer: AlohaCare Medicare |
$1,420.11
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,584.60
|
| Rate for Payer: Devoted Health Medicare |
$1,562.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,420.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,505.40
|
| Rate for Payer: Health Management Network Commercial |
$2,244.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,704.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,704.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,704.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,549.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,420.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,549.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,420.11
|
|
|
PR IN-SITU VEIN BYPASS FEMORAL-POPLITEAL
|
Professional
|
Both
|
$2,286.00
|
|
|
Service Code
|
HCPCS 35583
|
| Min. Negotiated Rate |
$1,228.10 |
| Max. Negotiated Rate |
$1,943.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,340.39
|
| Rate for Payer: AlohaCare Medicare |
$1,228.10
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Devoted Health Medicare |
$1,350.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,228.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,255.54
|
| Rate for Payer: Health Management Network Commercial |
$1,943.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,473.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,473.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,473.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,340.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,228.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,340.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,228.10
|
|
|
PR IN-SITU VEIN BYP POP-TIBL PRONEAL
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 35587
|
| Min. Negotiated Rate |
$1,139.94 |
| Max. Negotiated Rate |
$1,793.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,235.75
|
| Rate for Payer: AlohaCare Medicare |
$1,139.94
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Devoted Health Medicare |
$1,253.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,139.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,180.14
|
| Rate for Payer: Health Management Network Commercial |
$1,793.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,367.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,367.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,367.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,235.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,139.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,235.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,139.94
|
|
