|
PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW SF MDM 15 MIN
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 98000
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 98007
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VST NEW HIGH MDM 60 MIN
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 98003
|
| Min. Negotiated Rate |
$283.90 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Health Management Network Commercial |
$283.90
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$390.78 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: AlohaCare Medicaid |
$548.81
|
| Rate for Payer: AlohaCare Medicare |
$502.18
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Devoted Health Medicare |
$552.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$502.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.78
|
| Rate for Payer: Health Management Network Commercial |
$803.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$602.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$602.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$548.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$502.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$548.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$502.18
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$92.77
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: AlohaCare Medicaid |
$22.19
|
| Rate for Payer: AlohaCare Medicare |
$17.69
|
| Rate for Payer: Cash Price |
$55.66
|
| Rate for Payer: Cash Price |
$55.66
|
| Rate for Payer: Devoted Health Medicare |
$19.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.54
|
| Rate for Payer: Health Management Network Commercial |
$78.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.69
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$38.19
|
| Rate for Payer: AlohaCare Medicare |
$30.13
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$33.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.50
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.13
|
| Rate for Payer: University Health Alliance Commercial |
$43.67
|
|
|
PR TAP BLOCK BILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$278.86
|
|
|
Service Code
|
HCPCS 64488
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$237.03 |
| Rate for Payer: AlohaCare Medicaid |
$67.16
|
| Rate for Payer: AlohaCare Medicare |
$56.06
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Devoted Health Medicare |
$61.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$115.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$169.00
|
| Rate for Payer: Health Management Network Commercial |
$237.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.06
|
| Rate for Payer: University Health Alliance Commercial |
$73.25
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$238.24
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: AlohaCare Medicaid |
$53.89
|
| Rate for Payer: AlohaCare Medicare |
$48.04
|
| Rate for Payer: Cash Price |
$142.94
|
| Rate for Payer: Cash Price |
$142.94
|
| Rate for Payer: Devoted Health Medicare |
$52.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.54
|
| Rate for Payer: Health Management Network Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.04
|
| Rate for Payer: University Health Alliance Commercial |
$63.40
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$408.96
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$347.62 |
| Rate for Payer: AlohaCare Medicaid |
$116.57
|
| Rate for Payer: AlohaCare Medicare |
$104.19
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Devoted Health Medicare |
$114.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$173.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.92
|
| Rate for Payer: Health Management Network Commercial |
$347.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.19
|
| Rate for Payer: University Health Alliance Commercial |
$128.29
|
|
|
PR TC99M SULFUR COLLOID
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS A9541
|
| Min. Negotiated Rate |
$373.15 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Health Management Network Commercial |
$373.15
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$274.23 |
| Max. Negotiated Rate |
$461.55 |
| Rate for Payer: AlohaCare Medicaid |
$318.26
|
| Rate for Payer: AlohaCare Medicare |
$274.23
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Devoted Health Medicare |
$301.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$274.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$336.96
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$329.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$329.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$318.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$274.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$318.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$274.23
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$409.18 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: AlohaCare Medicaid |
$465.19
|
| Rate for Payer: AlohaCare Medicare |
$409.18
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Devoted Health Medicare |
$450.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$409.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$511.42
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$491.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$491.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$491.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$409.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$465.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$409.18
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$846.01 |
| Max. Negotiated Rate |
$1,348.10 |
| Rate for Payer: AlohaCare Medicaid |
$933.02
|
| Rate for Payer: AlohaCare Medicare |
$846.01
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Devoted Health Medicare |
$930.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$846.01
|
| Rate for Payer: Health Management Network Commercial |
$1,348.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,015.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,015.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,015.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$933.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$846.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$933.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$846.01
|
| Rate for Payer: University Health Alliance Commercial |
$1,300.00
|
|
|
PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 37216
|
| Min. Negotiated Rate |
$991.06 |
| Max. Negotiated Rate |
$1,439.05 |
| Rate for Payer: AlohaCare Medicaid |
$991.06
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Health Management Network Commercial |
$1,439.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$991.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$991.06
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$432.89 |
| Max. Negotiated Rate |
$707.20 |
| Rate for Payer: AlohaCare Medicaid |
$487.57
|
| Rate for Payer: AlohaCare Medicare |
$432.89
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Devoted Health Medicare |
$476.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$432.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$539.76
|
| Rate for Payer: Health Management Network Commercial |
$707.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$519.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$519.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$519.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$487.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$432.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$487.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$432.89
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$39.48
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Devoted Health Medicare |
$43.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.89
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.48
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$656.49
|
| Rate for Payer: AlohaCare Medicare |
$688.61
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$757.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$688.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$826.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$826.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$826.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$656.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$688.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$656.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$688.61
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicare |
$38.75
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$42.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.25
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.75
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$373.29 |
| Max. Negotiated Rate |
$588.20 |
| Rate for Payer: AlohaCare Medicaid |
$405.37
|
| Rate for Payer: AlohaCare Medicare |
$373.29
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Devoted Health Medicare |
$410.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.29
|
| Rate for Payer: Health Management Network Commercial |
$588.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$447.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$447.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$405.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.29
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$1,051.82 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,140.56
|
| Rate for Payer: AlohaCare Medicare |
$1,051.82
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Devoted Health Medicare |
$1,157.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,051.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,140.62
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,262.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,262.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,262.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,140.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,051.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,140.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,051.82
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$957.03 |
| Max. Negotiated Rate |
$1,507.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,042.60
|
| Rate for Payer: AlohaCare Medicare |
$957.03
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Devoted Health Medicare |
$1,052.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$957.03
|
| Rate for Payer: Health Management Network Commercial |
$1,507.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,148.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,148.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,148.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,042.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$957.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,042.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$957.03
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$1,037.21 |
| Max. Negotiated Rate |
$1,648.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,142.09
|
| Rate for Payer: AlohaCare Medicare |
$1,037.21
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Devoted Health Medicare |
$1,140.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,037.21
|
| Rate for Payer: Health Management Network Commercial |
$1,648.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,244.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,244.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,244.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,142.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,037.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,142.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,037.21
|
|
|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$1,089.41 |
| Max. Negotiated Rate |
$1,717.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,186.54
|
| Rate for Payer: AlohaCare Medicare |
$1,089.41
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Devoted Health Medicare |
$1,198.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,089.41
|
| Rate for Payer: Health Management Network Commercial |
$1,717.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,307.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,307.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,307.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,186.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,089.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,186.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,089.41
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$1,799.00
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$969.54 |
| Max. Negotiated Rate |
$1,529.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,056.32
|
| Rate for Payer: AlohaCare Medicare |
$971.97
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: Devoted Health Medicare |
$1,069.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$971.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$969.54
|
| Rate for Payer: Health Management Network Commercial |
$1,529.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,166.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,166.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,166.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,056.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$971.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,056.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$971.97
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$702.04 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: AlohaCare Medicaid |
$762.85
|
| Rate for Payer: AlohaCare Medicare |
$702.04
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Devoted Health Medicare |
$772.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$702.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network Commercial |
$1,105.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$842.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$842.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$842.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$762.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$702.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$762.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$702.04
|
|
