|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$88.99
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: AlohaCare Medicaid |
$40.75
|
| Rate for Payer: AlohaCare Medicare |
$35.28
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Devoted Health Medicare |
$38.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.96
|
| Rate for Payer: Health Management Network Commercial |
$75.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.28
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$28.58
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: AlohaCare Medicaid |
$12.90
|
| Rate for Payer: AlohaCare Medicare |
$11.02
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Devoted Health Medicare |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.14
|
| Rate for Payer: Health Management Network Commercial |
$24.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.02
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$972.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$403.78 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: AlohaCare Medicaid |
$571.25
|
| Rate for Payer: AlohaCare Medicare |
$518.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Devoted Health Medicare |
$570.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$403.78
|
| Rate for Payer: Health Management Network Commercial |
$826.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$621.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$621.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$571.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$571.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.20
|
|
|
PROPAFENONE 150 MG TABLET [11146]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 62559023001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
PROPAFENONE 150 MG TABLET [11146]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 62559023001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
PROPAFENONE 225 MG TABLET [11147]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 62559023101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
PROPAFENONE 225 MG TABLET [11147]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 62559023101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
PROPARACAINE 0.5 % EYE DROPS [6644]
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
NDC 61314001601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
|
|
PROPARACAINE 0.5 % EYE DROPS [6644]
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 24208073006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$45.88
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Devoted Health Medicare |
$50.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.60
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$45.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.88
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.88
|
| Rate for Payer: University Health Alliance Commercial |
$107.88
|
|
|
PROPARACAINE 0.5 % EYE DROPS [6644]
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
NDC 61314001601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: AlohaCare Medicaid |
$77.00
|
| Rate for Payer: AlohaCare Medicare |
$47.74
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Devoted Health Medicare |
$52.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.30
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Humana Medicare |
$47.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.74
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.74
|
| Rate for Payer: University Health Alliance Commercial |
$112.25
|
|
|
PROPARACAINE 0.5 % EYE DROPS [6644]
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 24208073006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
PROPATEN VASC GRAFT HAX01A
|
Facility
|
IP
|
$7,458.00
|
|
|
Service Code
|
HCPCS C1768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,176.48 |
| Max. Negotiated Rate |
$7,234.26 |
| Rate for Payer: Cash Price |
$4,474.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,220.60
|
| Rate for Payer: Health Management Network Commercial |
$6,339.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,712.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,234.26
|
| Rate for Payer: University Health Alliance Commercial |
$4,176.48
|
|
|
PROPATEN VASC GRAFT HAX01A
|
Facility
|
OP
|
$7,458.00
|
|
|
Service Code
|
HCPCS C1768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,311.98 |
| Max. Negotiated Rate |
$7,234.26 |
| Rate for Payer: AlohaCare Medicaid |
$3,729.00
|
| Rate for Payer: AlohaCare Medicare |
$2,311.98
|
| Rate for Payer: Cash Price |
$4,474.80
|
| Rate for Payer: Devoted Health Medicare |
$2,535.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,311.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,220.60
|
| Rate for Payer: Health Management Network Commercial |
$6,339.30
|
| Rate for Payer: Humana Medicare |
$2,311.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,712.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,803.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,311.98
|
| Rate for Payer: MDX Hawaii PPO |
$7,234.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,311.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,311.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,311.98
|
| Rate for Payer: University Health Alliance Commercial |
$4,176.48
|
|
|
PROPATEN VASC GRAFT HAX02A
|
Facility
|
IP
|
$9,318.00
|
|
|
Service Code
|
HCPCS C1768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,218.08 |
| Max. Negotiated Rate |
$9,038.46 |
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,522.60
|
| Rate for Payer: Health Management Network Commercial |
$7,920.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,386.20
|
| Rate for Payer: MDX Hawaii PPO |
$9,038.46
|
| Rate for Payer: University Health Alliance Commercial |
$5,218.08
|
|
|
PROPATEN VASC GRAFT HAX02A
|
Facility
|
OP
|
$9,318.00
|
|
|
Service Code
|
HCPCS C1768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.58 |
| Max. Negotiated Rate |
$9,038.46 |
| Rate for Payer: AlohaCare Medicaid |
$4,659.00
|
| Rate for Payer: AlohaCare Medicare |
$2,888.58
|
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Devoted Health Medicare |
$3,168.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,888.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,522.60
|
| Rate for Payer: Health Management Network Commercial |
$7,920.30
|
| Rate for Payer: Humana Medicare |
$2,888.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,386.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,752.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,888.58
|
| Rate for Payer: MDX Hawaii PPO |
$9,038.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,888.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,888.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,888.58
|
| Rate for Payer: University Health Alliance Commercial |
$5,218.08
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$431.36 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: AlohaCare Medicaid |
$451.97
|
| Rate for Payer: AlohaCare Medicare |
$431.36
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Devoted Health Medicare |
$474.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$431.36
|
| Rate for Payer: Health Management Network Commercial |
$657.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$517.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$517.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$517.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$431.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$451.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$431.36
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5.1-10 CM
|
Professional
|
Both
|
$2,833.00
|
|
|
Service Code
|
HCPCS 49187
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2,408.05 |
| Rate for Payer: AlohaCare Medicaid |
$1.61
|
| Rate for Payer: AlohaCare Medicare |
$1,510.87
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Devoted Health Medicare |
$1,661.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,510.87
|
| Rate for Payer: Health Management Network Commercial |
$2,408.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,813.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,813.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,813.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,510.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,510.87
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,237.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1,901.45 |
| Rate for Payer: AlohaCare Medicaid |
$1.27
|
| Rate for Payer: AlohaCare Medicare |
$1,200.45
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Devoted Health Medicare |
$1,320.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,200.45
|
| Rate for Payer: Health Management Network Commercial |
$1,901.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,440.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,440.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,440.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,200.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,200.45
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,142.49
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$615.03 |
| Max. Negotiated Rate |
$971.12 |
| Rate for Payer: AlohaCare Medicaid |
$615.03
|
| Rate for Payer: AlohaCare Medicare |
$652.47
|
| Rate for Payer: Cash Price |
$685.49
|
| Rate for Payer: Cash Price |
$685.49
|
| Rate for Payer: Devoted Health Medicare |
$717.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$650.52
|
| Rate for Payer: Health Management Network Commercial |
$971.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$782.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$782.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$615.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$615.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.47
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$722.27 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: AlohaCare Medicaid |
$851.79
|
| Rate for Payer: AlohaCare Medicare |
$722.27
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Devoted Health Medicare |
$794.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$722.27
|
| Rate for Payer: Health Management Network Commercial |
$1,236.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$866.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$866.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$866.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$851.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$722.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$851.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$722.27
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$3,263.22
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$2,773.74 |
| Rate for Payer: AlohaCare Medicaid |
$141.24
|
| Rate for Payer: AlohaCare Medicare |
$125.36
|
| Rate for Payer: Cash Price |
$1,957.93
|
| Rate for Payer: Cash Price |
$1,957.93
|
| Rate for Payer: Devoted Health Medicare |
$137.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$225.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,381.08
|
| Rate for Payer: Health Management Network Commercial |
$2,773.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.36
|
| Rate for Payer: University Health Alliance Commercial |
$300.00
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$2,355.34
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$175.85 |
| Max. Negotiated Rate |
$2,878.72 |
| Rate for Payer: AlohaCare Medicaid |
$195.35
|
| Rate for Payer: AlohaCare Medicare |
$175.85
|
| Rate for Payer: Cash Price |
$1,413.20
|
| Rate for Payer: Cash Price |
$1,413.20
|
| Rate for Payer: Devoted Health Medicare |
$193.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$313.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,878.72
|
| Rate for Payer: Health Management Network Commercial |
$2,002.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.85
|
| Rate for Payer: University Health Alliance Commercial |
$265.57
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$5,043.31
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$367.82 |
| Max. Negotiated Rate |
$4,801.68 |
| Rate for Payer: AlohaCare Medicaid |
$410.31
|
| Rate for Payer: AlohaCare Medicare |
$367.82
|
| Rate for Payer: Cash Price |
$3,025.99
|
| Rate for Payer: Cash Price |
$3,025.99
|
| Rate for Payer: Devoted Health Medicare |
$404.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$410.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$666.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$410.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,801.68
|
| Rate for Payer: Health Management Network Commercial |
$4,286.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.82
|
| Rate for Payer: University Health Alliance Commercial |
$667.00
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$6,433.38
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$5,468.37 |
| Rate for Payer: AlohaCare Medicaid |
$288.49
|
| Rate for Payer: AlohaCare Medicare |
$257.93
|
| Rate for Payer: Cash Price |
$3,860.03
|
| Rate for Payer: Cash Price |
$3,860.03
|
| Rate for Payer: Devoted Health Medicare |
$283.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$288.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$466.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$288.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,924.66
|
| Rate for Payer: Health Management Network Commercial |
$5,468.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$309.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.93
|
| Rate for Payer: University Health Alliance Commercial |
$466.88
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$708.76 |
| Max. Negotiated Rate |
$1,241.00 |
| Rate for Payer: AlohaCare Medicaid |
$849.71
|
| Rate for Payer: AlohaCare Medicare |
$775.96
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Devoted Health Medicare |
$853.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$775.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.76
|
| Rate for Payer: Health Management Network Commercial |
$1,241.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$931.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$931.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$849.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$775.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$849.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$775.96
|
|
