|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$268.36
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$228.11 |
| Rate for Payer: AlohaCare Medicare |
$79.30
|
| Rate for Payer: Cash Price |
$161.02
|
| Rate for Payer: Cash Price |
$161.02
|
| Rate for Payer: Devoted Health Medicare |
$87.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.18
|
| Rate for Payer: Health Management Network Commercial |
$228.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.30
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$236.08 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: AlohaCare Medicaid |
$402.70
|
| Rate for Payer: AlohaCare Medicare |
$369.28
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Devoted Health Medicare |
$406.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.08
|
| Rate for Payer: Health Management Network Commercial |
$903.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.28
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 51728 26
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$402.70 |
| Rate for Payer: AlohaCare Medicaid |
$402.70
|
| Rate for Payer: AlohaCare Medicare |
$105.33
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$115.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.08
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.33
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 51728 TC
|
| Min. Negotiated Rate |
$236.08 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: AlohaCare Medicaid |
$402.70
|
| Rate for Payer: AlohaCare Medicare |
$263.95
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Devoted Health Medicare |
$290.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$263.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.08
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$263.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$263.95
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$31.27
|
|
|
Service Code
|
HCPCS G2211
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$26.58 |
| Rate for Payer: AlohaCare Medicaid |
$16.71
|
| Rate for Payer: AlohaCare Medicare |
$14.45
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Devoted Health Medicare |
$15.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.61
|
| Rate for Payer: Health Management Network Commercial |
$26.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.45
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 51741 TC
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$15.02
|
| Rate for Payer: AlohaCare Medicare |
$7.41
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Devoted Health Medicare |
$8.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.41
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$15.02
|
| Rate for Payer: AlohaCare Medicare |
$16.13
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$17.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.13
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 51741 26
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: AlohaCare Medicaid |
$15.02
|
| Rate for Payer: AlohaCare Medicare |
$8.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.72
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 51729 26
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: AlohaCare Medicaid |
$422.10
|
| Rate for Payer: AlohaCare Medicare |
$126.74
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Devoted Health Medicare |
$139.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.98
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.74
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$422.10
|
| Rate for Payer: AlohaCare Medicare |
$385.57
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Devoted Health Medicare |
$424.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.98
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$462.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$462.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$462.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.57
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 51729 TC
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: AlohaCare Medicaid |
$422.10
|
| Rate for Payer: AlohaCare Medicare |
$258.82
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Devoted Health Medicare |
$284.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$258.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.98
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$310.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$310.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$310.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$258.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$258.82
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$65.97
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: AlohaCare Medicaid |
$32.59
|
| Rate for Payer: AlohaCare Medicare |
$26.31
|
| Rate for Payer: Cash Price |
$39.58
|
| Rate for Payer: Cash Price |
$39.58
|
| Rate for Payer: Devoted Health Medicare |
$28.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.51
|
| Rate for Payer: Health Management Network Commercial |
$56.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.31
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$99.25
|
| Rate for Payer: AlohaCare Medicare |
$98.55
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$108.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.86
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.55
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$548.59
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$234.87 |
| Max. Negotiated Rate |
$466.30 |
| Rate for Payer: AlohaCare Medicaid |
$265.89
|
| Rate for Payer: AlohaCare Medicare |
$234.87
|
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Devoted Health Medicare |
$258.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$265.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$441.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$265.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.98
|
| Rate for Payer: Health Management Network Commercial |
$466.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$281.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$265.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.87
|
| Rate for Payer: University Health Alliance Commercial |
$327.66
|
|
|
PR CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE
|
Professional
|
Both
|
$252.44
|
|
|
Service Code
|
HCPCS 49465
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$214.57 |
| Rate for Payer: AlohaCare Medicaid |
$29.79
|
| Rate for Payer: AlohaCare Medicare |
$25.38
|
| Rate for Payer: Cash Price |
$151.46
|
| Rate for Payer: Cash Price |
$151.46
|
| Rate for Payer: Devoted Health Medicare |
$27.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$50.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.79
|
| Rate for Payer: Health Management Network Commercial |
$214.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.38
|
| Rate for Payer: University Health Alliance Commercial |
$39.55
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$508.53
|
|
|
Service Code
|
HCPCS 30903
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: AlohaCare Medicaid |
$75.24
|
| Rate for Payer: AlohaCare Medicare |
$67.29
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Devoted Health Medicare |
$74.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$126.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$432.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.29
|
| Rate for Payer: University Health Alliance Commercial |
$93.56
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Professional
|
Both
|
$314.88
|
|
|
Service Code
|
HCPCS 30901
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$267.65 |
| Rate for Payer: AlohaCare Medicaid |
$55.46
|
| Rate for Payer: AlohaCare Medicare |
$48.15
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Devoted Health Medicare |
$52.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$267.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.15
|
| Rate for Payer: University Health Alliance Commercial |
$68.69
|
|
|
PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,484.65
|
|
|
Service Code
|
HCPCS 49446
|
| Min. Negotiated Rate |
$123.39 |
| Max. Negotiated Rate |
$1,261.95 |
| Rate for Payer: AlohaCare Medicaid |
$141.30
|
| Rate for Payer: AlohaCare Medicare |
$123.39
|
| Rate for Payer: Cash Price |
$890.79
|
| Rate for Payer: Cash Price |
$890.79
|
| Rate for Payer: Devoted Health Medicare |
$135.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.30
|
| Rate for Payer: Health Management Network Commercial |
$1,261.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.39
|
|
|
PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ
|
Professional
|
Both
|
$1,679.95
|
|
|
Service Code
|
HCPCS 50434
|
| Min. Negotiated Rate |
$165.12 |
| Max. Negotiated Rate |
$1,427.96 |
| Rate for Payer: AlohaCare Medicaid |
$186.23
|
| Rate for Payer: AlohaCare Medicare |
$165.12
|
| Rate for Payer: Cash Price |
$1,007.97
|
| Rate for Payer: Cash Price |
$1,007.97
|
| Rate for Payer: Devoted Health Medicare |
$181.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$331.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$186.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,034.80
|
| Rate for Payer: Health Management Network Commercial |
$1,427.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.12
|
| Rate for Payer: University Health Alliance Commercial |
$247.88
|
|
|
PR CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH
|
Professional
|
Both
|
$1,644.54
|
|
|
Service Code
|
HCPCS 47535
|
| Min. Negotiated Rate |
$166.91 |
| Max. Negotiated Rate |
$1,397.86 |
| Rate for Payer: AlohaCare Medicaid |
$189.82
|
| Rate for Payer: AlohaCare Medicare |
$166.91
|
| Rate for Payer: Cash Price |
$986.72
|
| Rate for Payer: Cash Price |
$986.72
|
| Rate for Payer: Devoted Health Medicare |
$183.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$365.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,271.14
|
| Rate for Payer: Health Management Network Commercial |
$1,397.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.91
|
| Rate for Payer: University Health Alliance Commercial |
$254.04
|
|
|
PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$2,897.00
|
|
|
Service Code
|
HCPCS 27132
|
| Min. Negotiated Rate |
$1,465.88 |
| Max. Negotiated Rate |
$2,462.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,687.72
|
| Rate for Payer: AlohaCare Medicare |
$1,496.50
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Devoted Health Medicare |
$1,646.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,496.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,465.88
|
| Rate for Payer: Health Management Network Commercial |
$2,462.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,795.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,795.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,795.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,687.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,496.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,687.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,496.50
|
|
|
PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG
|
Professional
|
Both
|
$1,565.76
|
|
|
Service Code
|
HCPCS 32408
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$1,330.90 |
| Rate for Payer: AlohaCare Medicaid |
$148.55
|
| Rate for Payer: AlohaCare Medicare |
$127.97
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Devoted Health Medicare |
$140.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$253.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,086.28
|
| Rate for Payer: Health Management Network Commercial |
$1,330.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.97
|
| Rate for Payer: University Health Alliance Commercial |
$184.28
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,116.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$503.36 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: AlohaCare Medicaid |
$650.77
|
| Rate for Payer: AlohaCare Medicare |
$586.31
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Devoted Health Medicare |
$644.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$586.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$503.36
|
| Rate for Payer: Health Management Network Commercial |
$948.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$703.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$703.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$703.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$586.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$650.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$586.31
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,453.85
|
| Rate for Payer: AlohaCare Medicare |
$1,334.03
|
| Rate for Payer: Cash Price |
$1,498.80
|
| Rate for Payer: Cash Price |
$1,498.80
|
| Rate for Payer: Devoted Health Medicare |
$1,467.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,334.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$611.00
|
| Rate for Payer: Health Management Network Commercial |
$2,123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,600.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,600.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,600.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,453.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,334.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,453.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,334.03
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: AlohaCare Medicaid |
$6.43
|
| Rate for Payer: AlohaCare Medicare |
$15.27
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.27
|
|
