|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 93288 26
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: AlohaCare Medicaid |
$61.73
|
| Rate for Payer: AlohaCare Medicare |
$20.68
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Devoted Health Medicare |
$22.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.68
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.68
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 93291 TC
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$34.75
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.75
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 93291 26
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$53.61 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$17.91
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$19.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.91
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93291
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.61
|
| Rate for Payer: AlohaCare Medicare |
$52.67
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$57.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.77
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.67
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 93289 TC
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$40.45
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$44.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.45
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 93289 26
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$77.73 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Devoted Health Medicare |
$40.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.36
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 93289
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$77.73
|
| Rate for Payer: AlohaCare Medicare |
$76.80
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Devoted Health Medicare |
$84.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.24
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.80
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$706.62
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$600.63 |
| Rate for Payer: AlohaCare Medicaid |
$402.86
|
| Rate for Payer: AlohaCare Medicare |
$403.78
|
| Rate for Payer: Cash Price |
$423.97
|
| Rate for Payer: Cash Price |
$423.97
|
| Rate for Payer: Devoted Health Medicare |
$444.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$369.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$403.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.26
|
| Rate for Payer: Health Management Network Commercial |
$600.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$484.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.78
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$648.11
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$550.89 |
| Rate for Payer: AlohaCare Medicaid |
$362.75
|
| Rate for Payer: AlohaCare Medicare |
$370.35
|
| Rate for Payer: Cash Price |
$388.87
|
| Rate for Payer: Cash Price |
$388.87
|
| Rate for Payer: Devoted Health Medicare |
$407.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$376.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$370.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$550.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$444.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$444.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$444.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$362.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$370.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$362.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$370.35
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$249.66
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$117.59 |
| Max. Negotiated Rate |
$212.21 |
| Rate for Payer: AlohaCare Medicaid |
$132.48
|
| Rate for Payer: AlohaCare Medicare |
$117.59
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: Devoted Health Medicare |
$129.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.44
|
| Rate for Payer: Health Management Network Commercial |
$212.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.59
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$817.34
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$694.74 |
| Rate for Payer: AlohaCare Medicaid |
$301.91
|
| Rate for Payer: AlohaCare Medicare |
$274.89
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Devoted Health Medicare |
$302.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$301.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$274.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$301.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.10
|
| Rate for Payer: Health Management Network Commercial |
$694.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$329.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$329.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$301.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$274.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$301.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$274.89
|
| Rate for Payer: University Health Alliance Commercial |
$387.74
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE
|
Professional
|
Both
|
$633.18
|
|
|
Service Code
|
HCPCS 41007
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: AlohaCare Medicaid |
$232.79
|
| Rate for Payer: AlohaCare Medicare |
$213.71
|
| Rate for Payer: Cash Price |
$379.91
|
| Rate for Payer: Cash Price |
$379.91
|
| Rate for Payer: Devoted Health Medicare |
$235.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$232.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$353.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$232.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.92
|
| Rate for Payer: Health Management Network Commercial |
$538.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.71
|
| Rate for Payer: University Health Alliance Commercial |
$299.25
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$781.80
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$664.53 |
| Rate for Payer: AlohaCare Medicaid |
$271.80
|
| Rate for Payer: AlohaCare Medicare |
$253.82
|
| Rate for Payer: Cash Price |
$469.08
|
| Rate for Payer: Cash Price |
$469.08
|
| Rate for Payer: Devoted Health Medicare |
$279.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$271.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$411.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$253.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$271.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.32
|
| Rate for Payer: Health Management Network Commercial |
$664.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$304.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$304.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$253.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$271.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$253.82
|
| Rate for Payer: University Health Alliance Commercial |
$348.81
|
|
|
PR INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
|
|
PR INTRAVASCULAR LITHOTRIPSY FPVT W/IN SAME ARTERY
|
Professional
|
Both
|
$9,166.00
|
|
|
Service Code
|
HCPCS 37279
|
| Min. Negotiated Rate |
$173.19 |
| Max. Negotiated Rate |
$7,791.10 |
| Rate for Payer: AlohaCare Medicare |
$173.19
|
| Rate for Payer: Cash Price |
$5,499.60
|
| Rate for Payer: Cash Price |
$5,499.60
|
| Rate for Payer: Devoted Health Medicare |
$190.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.19
|
| Rate for Payer: Health Management Network Commercial |
$7,791.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.19
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$317.94
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: AlohaCare Medicaid |
$66.36
|
| Rate for Payer: AlohaCare Medicare |
$59.39
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Devoted Health Medicare |
$65.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.84
|
| Rate for Payer: Health Management Network Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.39
|
| Rate for Payer: University Health Alliance Commercial |
$89.42
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$1,756.95
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$75.06 |
| Max. Negotiated Rate |
$1,638.78 |
| Rate for Payer: AlohaCare Medicaid |
$83.28
|
| Rate for Payer: AlohaCare Medicare |
$75.06
|
| Rate for Payer: Cash Price |
$1,054.17
|
| Rate for Payer: Cash Price |
$1,054.17
|
| Rate for Payer: Devoted Health Medicare |
$82.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,638.78
|
| Rate for Payer: Health Management Network Commercial |
$1,493.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.06
|
| Rate for Payer: University Health Alliance Commercial |
$112.60
|
|
|
PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 67028
|
| Min. Negotiated Rate |
$77.37 |
| Max. Negotiated Rate |
$201.99 |
| Rate for Payer: AlohaCare Medicaid |
$94.36
|
| Rate for Payer: AlohaCare Medicare |
$77.37
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Devoted Health Medicare |
$85.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$201.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.37
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: AlohaCare Medicaid |
$126.81
|
| Rate for Payer: AlohaCare Medicare |
$109.22
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$120.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$126.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$185.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$126.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.44
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.22
|
| Rate for Payer: University Health Alliance Commercial |
$167.68
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$1,323.51
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$1,124.98 |
| Rate for Payer: AlohaCare Medicaid |
$160.76
|
| Rate for Payer: AlohaCare Medicare |
$142.96
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Devoted Health Medicare |
$157.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$160.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$255.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.58
|
| Rate for Payer: Health Management Network Commercial |
$1,124.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.96
|
| Rate for Payer: University Health Alliance Commercial |
$230.00
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$9,480.03
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$267.88 |
| Max. Negotiated Rate |
$8,058.03 |
| Rate for Payer: AlohaCare Medicaid |
$299.64
|
| Rate for Payer: AlohaCare Medicare |
$267.88
|
| Rate for Payer: Cash Price |
$5,688.02
|
| Rate for Payer: Cash Price |
$5,688.02
|
| Rate for Payer: Devoted Health Medicare |
$294.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$299.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$477.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$267.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$299.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,484.92
|
| Rate for Payer: Health Management Network Commercial |
$8,058.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$267.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$267.88
|
| Rate for Payer: University Health Alliance Commercial |
$420.66
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$2,309.41
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$203.90 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: AlohaCare Medicaid |
$229.30
|
| Rate for Payer: AlohaCare Medicare |
$203.90
|
| Rate for Payer: Cash Price |
$1,385.65
|
| Rate for Payer: Cash Price |
$1,385.65
|
| Rate for Payer: Devoted Health Medicare |
$224.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$229.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$229.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,388.40
|
| Rate for Payer: Health Management Network Commercial |
$1,963.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.90
|
| Rate for Payer: University Health Alliance Commercial |
$308.42
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$1,283.50 |
| Rate for Payer: AlohaCare Medicaid |
$121.02
|
| Rate for Payer: AlohaCare Medicare |
$108.89
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Devoted Health Medicare |
$119.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$121.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$1,283.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.89
|
| Rate for Payer: University Health Alliance Commercial |
$160.34
|
|
|
PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA
|
Professional
|
Both
|
$989.73
|
|
|
Service Code
|
HCPCS 36010
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$841.27 |
| Rate for Payer: AlohaCare Medicaid |
$102.60
|
| Rate for Payer: AlohaCare Medicare |
$90.85
|
| Rate for Payer: Cash Price |
$593.84
|
| Rate for Payer: Cash Price |
$593.84
|
| Rate for Payer: Devoted Health Medicare |
$99.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$841.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.85
|
| Rate for Payer: University Health Alliance Commercial |
$138.98
|
|
|
PR INTRODUCTION CATHETER AORTA
|
Professional
|
Both
|
$1,085.98
|
|
|
Service Code
|
HCPCS 36200
|
| Min. Negotiated Rate |
$115.84 |
| Max. Negotiated Rate |
$923.08 |
| Rate for Payer: AlohaCare Medicaid |
$129.99
|
| Rate for Payer: AlohaCare Medicare |
$115.84
|
| Rate for Payer: Cash Price |
$651.59
|
| Rate for Payer: Cash Price |
$651.59
|
| Rate for Payer: Devoted Health Medicare |
$127.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$210.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.70
|
| Rate for Payer: Health Management Network Commercial |
$923.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.84
|
| Rate for Payer: University Health Alliance Commercial |
$211.00
|
|
