|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$1,455.48
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$126.09 |
| Max. Negotiated Rate |
$1,237.16 |
| Rate for Payer: AlohaCare Medicaid |
$144.30
|
| Rate for Payer: AlohaCare Medicare |
$126.09
|
| Rate for Payer: Cash Price |
$873.29
|
| Rate for Payer: Cash Price |
$873.29
|
| Rate for Payer: Devoted Health Medicare |
$138.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.66
|
| Rate for Payer: Health Management Network Commercial |
$1,237.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.09
|
| Rate for Payer: University Health Alliance Commercial |
$194.12
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,073.28
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$232.27 |
| Max. Negotiated Rate |
$1,762.29 |
| Rate for Payer: AlohaCare Medicaid |
$257.36
|
| Rate for Payer: AlohaCare Medicare |
$232.27
|
| Rate for Payer: Cash Price |
$1,243.97
|
| Rate for Payer: Cash Price |
$1,243.97
|
| Rate for Payer: Devoted Health Medicare |
$255.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$257.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$257.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.32
|
| Rate for Payer: Health Management Network Commercial |
$1,762.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$278.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$257.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.27
|
| Rate for Payer: University Health Alliance Commercial |
$344.88
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,514.98
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$1,287.73 |
| Rate for Payer: AlohaCare Medicaid |
$237.01
|
| Rate for Payer: AlohaCare Medicare |
$209.84
|
| Rate for Payer: Cash Price |
$908.99
|
| Rate for Payer: Cash Price |
$908.99
|
| Rate for Payer: Devoted Health Medicare |
$230.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$237.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$378.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$237.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.10
|
| Rate for Payer: Health Management Network Commercial |
$1,287.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$251.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.84
|
| Rate for Payer: University Health Alliance Commercial |
$380.00
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$2,620.78
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$2,227.66 |
| Rate for Payer: AlohaCare Medicaid |
$282.25
|
| Rate for Payer: AlohaCare Medicare |
$248.92
|
| Rate for Payer: Cash Price |
$1,572.47
|
| Rate for Payer: Cash Price |
$1,572.47
|
| Rate for Payer: Devoted Health Medicare |
$273.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$282.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$451.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$282.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$379.60
|
| Rate for Payer: Health Management Network Commercial |
$2,227.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.92
|
| Rate for Payer: University Health Alliance Commercial |
$452.00
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$3,835.40
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$286.36 |
| Max. Negotiated Rate |
$3,260.09 |
| Rate for Payer: AlohaCare Medicaid |
$314.28
|
| Rate for Payer: AlohaCare Medicare |
$286.36
|
| Rate for Payer: Cash Price |
$2,301.24
|
| Rate for Payer: Cash Price |
$2,301.24
|
| Rate for Payer: Devoted Health Medicare |
$315.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$314.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$492.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$314.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.12
|
| Rate for Payer: Health Management Network Commercial |
$3,260.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$343.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$343.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$343.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$314.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.36
|
| Rate for Payer: University Health Alliance Commercial |
$416.56
|
|
|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$2,322.23
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$198.70 |
| Max. Negotiated Rate |
$1,973.90 |
| Rate for Payer: AlohaCare Medicaid |
$223.83
|
| Rate for Payer: AlohaCare Medicare |
$198.70
|
| Rate for Payer: Cash Price |
$1,393.34
|
| Rate for Payer: Cash Price |
$1,393.34
|
| Rate for Payer: Devoted Health Medicare |
$218.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$223.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$356.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$223.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.76
|
| Rate for Payer: Health Management Network Commercial |
$1,973.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.70
|
| Rate for Payer: University Health Alliance Commercial |
$360.00
|
|
|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,065.91
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$183.63 |
| Max. Negotiated Rate |
$1,756.02 |
| Rate for Payer: AlohaCare Medicaid |
$205.09
|
| Rate for Payer: AlohaCare Medicare |
$183.63
|
| Rate for Payer: Cash Price |
$1,239.55
|
| Rate for Payer: Cash Price |
$1,239.55
|
| Rate for Payer: Devoted Health Medicare |
$201.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$205.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$337.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$205.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.24
|
| Rate for Payer: Health Management Network Commercial |
$1,756.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$220.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.63
|
| Rate for Payer: University Health Alliance Commercial |
$275.36
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$211.54
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$179.81 |
| Rate for Payer: AlohaCare Medicaid |
$46.19
|
| Rate for Payer: AlohaCare Medicare |
$40.37
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Devoted Health Medicare |
$44.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$73.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$179.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.37
|
| Rate for Payer: University Health Alliance Commercial |
$65.02
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$442.54
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$376.16 |
| Rate for Payer: AlohaCare Medicaid |
$49.78
|
| Rate for Payer: AlohaCare Medicare |
$44.39
|
| Rate for Payer: Cash Price |
$265.52
|
| Rate for Payer: Cash Price |
$265.52
|
| Rate for Payer: Devoted Health Medicare |
$48.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$376.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.39
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$1,537.71
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$1,307.05 |
| Rate for Payer: AlohaCare Medicaid |
$164.83
|
| Rate for Payer: AlohaCare Medicare |
$144.59
|
| Rate for Payer: Cash Price |
$922.63
|
| Rate for Payer: Cash Price |
$922.63
|
| Rate for Payer: Devoted Health Medicare |
$159.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$164.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$260.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$164.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.36
|
| Rate for Payer: Health Management Network Commercial |
$1,307.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.59
|
| Rate for Payer: University Health Alliance Commercial |
$220.42
|
|
|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$1,515.03
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$1,287.78 |
| Rate for Payer: AlohaCare Medicaid |
$148.27
|
| Rate for Payer: AlohaCare Medicare |
$131.26
|
| Rate for Payer: Cash Price |
$909.02
|
| Rate for Payer: Cash Price |
$909.02
|
| Rate for Payer: Devoted Health Medicare |
$144.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$237.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$146.12
|
| Rate for Payer: Health Management Network Commercial |
$1,287.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.26
|
| Rate for Payer: University Health Alliance Commercial |
$201.03
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$1,561.37
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$1,327.16 |
| Rate for Payer: AlohaCare Medicaid |
$165.35
|
| Rate for Payer: AlohaCare Medicare |
$147.49
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Devoted Health Medicare |
$162.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$262.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$180.18
|
| Rate for Payer: Health Management Network Commercial |
$1,327.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.49
|
| Rate for Payer: University Health Alliance Commercial |
$221.95
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$3,468.17
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$277.41 |
| Max. Negotiated Rate |
$2,947.94 |
| Rate for Payer: AlohaCare Medicaid |
$308.66
|
| Rate for Payer: AlohaCare Medicare |
$277.41
|
| Rate for Payer: Cash Price |
$2,080.90
|
| Rate for Payer: Cash Price |
$2,080.90
|
| Rate for Payer: Devoted Health Medicare |
$305.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$308.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$481.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$308.66
|
| Rate for Payer: Health Management Network Commercial |
$2,947.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$332.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$277.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$308.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$277.41
|
| Rate for Payer: University Health Alliance Commercial |
$407.86
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$4,439.75
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$3,773.79 |
| Rate for Payer: AlohaCare Medicaid |
$347.57
|
| Rate for Payer: AlohaCare Medicare |
$310.80
|
| Rate for Payer: Cash Price |
$2,663.85
|
| Rate for Payer: Cash Price |
$2,663.85
|
| Rate for Payer: Devoted Health Medicare |
$341.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$347.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$543.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$347.57
|
| Rate for Payer: Health Management Network Commercial |
$3,773.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$347.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$347.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.80
|
| Rate for Payer: University Health Alliance Commercial |
$505.00
|
|
|
PR SLINGS
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: AlohaCare Medicaid |
$10.40
|
| Rate for Payer: AlohaCare Medicare |
$10.98
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.55
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.98
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$379.14
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: AlohaCare Medicaid |
$145.39
|
| Rate for Payer: AlohaCare Medicare |
$132.34
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Devoted Health Medicare |
$145.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$221.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.40
|
| Rate for Payer: Health Management Network Commercial |
$322.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.34
|
| Rate for Payer: University Health Alliance Commercial |
$187.22
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$260.42
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$221.36 |
| Rate for Payer: AlohaCare Medicaid |
$57.36
|
| Rate for Payer: AlohaCare Medicare |
$55.77
|
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Devoted Health Medicare |
$61.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$57.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.28
|
| Rate for Payer: Health Management Network Commercial |
$221.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.77
|
| Rate for Payer: University Health Alliance Commercial |
$140.00
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$390.62
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: AlohaCare Medicaid |
$90.64
|
| Rate for Payer: AlohaCare Medicare |
$85.36
|
| Rate for Payer: Cash Price |
$234.37
|
| Rate for Payer: Cash Price |
$234.37
|
| Rate for Payer: Devoted Health Medicare |
$93.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$332.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.36
|
| Rate for Payer: University Health Alliance Commercial |
$106.30
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$442.56
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$376.18 |
| Rate for Payer: AlohaCare Medicaid |
$111.28
|
| Rate for Payer: AlohaCare Medicare |
$104.02
|
| Rate for Payer: Cash Price |
$265.54
|
| Rate for Payer: Cash Price |
$265.54
|
| Rate for Payer: Devoted Health Medicare |
$114.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$169.52
|
| Rate for Payer: Health Management Network Commercial |
$376.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.02
|
| Rate for Payer: University Health Alliance Commercial |
$130.81
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$33.08
|
| Rate for Payer: AlohaCare Medicare |
$33.61
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$36.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.29
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.61
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$51.44
|
| Rate for Payer: AlohaCare Medicare |
$52.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$57.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.77
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.60
|
|
|
PR SPEECH AUDIOM THRESHLD AUTO W/SPEECH RECOGNITION
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 0211T
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$592.36
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$503.51 |
| Rate for Payer: AlohaCare Medicaid |
$159.59
|
| Rate for Payer: AlohaCare Medicare |
$150.13
|
| Rate for Payer: Cash Price |
$355.42
|
| Rate for Payer: Cash Price |
$355.42
|
| Rate for Payer: Devoted Health Medicare |
$165.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$188.50
|
| Rate for Payer: Health Management Network Commercial |
$503.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.13
|
| Rate for Payer: University Health Alliance Commercial |
$213.56
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: AlohaCare Medicaid |
$252.46
|
| Rate for Payer: AlohaCare Medicare |
$226.07
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Devoted Health Medicare |
$248.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.16
|
| Rate for Payer: Health Management Network Commercial |
$367.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$271.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.07
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$736.84 |
| Max. Negotiated Rate |
$1,643.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,128.66
|
| Rate for Payer: AlohaCare Medicare |
$1,044.28
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Devoted Health Medicare |
$1,148.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,044.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$736.84
|
| Rate for Payer: Health Management Network Commercial |
$1,643.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,253.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,253.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,128.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,044.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,128.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,044.28
|
|
