|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$145.23
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$43.87 |
| Max. Negotiated Rate |
$123.45 |
| Rate for Payer: AlohaCare Medicare |
$43.87
|
| Rate for Payer: Cash Price |
$87.14
|
| Rate for Payer: Cash Price |
$87.14
|
| Rate for Payer: Devoted Health Medicare |
$48.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.08
|
| Rate for Payer: Health Management Network Commercial |
$123.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.87
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 0055T
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.76
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 20985
|
| Min. Negotiated Rate |
$120.41 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$142.08
|
| Rate for Payer: AlohaCare Medicare |
$120.41
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Devoted Health Medicare |
$132.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.41
|
|
|
PR CRANIECTOMY W/EXCISION TUMOR/OTH BONE LESION SKL
|
Professional
|
Both
|
$2,218.00
|
|
|
Service Code
|
HCPCS 61500
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$1,885.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.43
|
| Rate for Payer: AlohaCare Medicare |
$1,173.61
|
| Rate for Payer: Cash Price |
$1,330.80
|
| Rate for Payer: Cash Price |
$1,330.80
|
| Rate for Payer: Devoted Health Medicare |
$1,290.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,173.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,457.30
|
| Rate for Payer: Health Management Network Commercial |
$1,885.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,408.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,408.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,408.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,173.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,173.61
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Professional
|
Both
|
$240.98
|
|
|
Service Code
|
HCPCS 99292
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$204.83 |
| Rate for Payer: AlohaCare Medicaid |
$105.97
|
| Rate for Payer: AlohaCare Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Devoted Health Medicare |
$109.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.90
|
| Rate for Payer: Health Management Network Commercial |
$204.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.35
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Professional
|
Both
|
$563.71
|
|
|
Service Code
|
HCPCS 99291
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$479.15 |
| Rate for Payer: AlohaCare Medicaid |
$210.80
|
| Rate for Payer: AlohaCare Medicare |
$197.18
|
| Rate for Payer: Cash Price |
$338.23
|
| Rate for Payer: Cash Price |
$338.23
|
| Rate for Payer: Devoted Health Medicare |
$216.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$210.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$210.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$251.64
|
| Rate for Payer: Health Management Network Commercial |
$479.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.18
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 99466
|
| Min. Negotiated Rate |
$202.24 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: AlohaCare Medicaid |
$232.54
|
| Rate for Payer: AlohaCare Medicare |
$202.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Devoted Health Medicare |
$222.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.24
|
| Rate for Payer: Health Management Network Commercial |
$334.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.24
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 99467
|
| Min. Negotiated Rate |
$101.29 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$116.72
|
| Rate for Payer: AlohaCare Medicare |
$101.29
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$111.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.29
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.29
|
|
|
PR CRNEC/CRNOT HMTMA SUPRATENTORIAL XDRL/SUBDURAL
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 61312
|
| Min. Negotiated Rate |
$1,432.08 |
| Max. Negotiated Rate |
$2,929.95 |
| Rate for Payer: AlohaCare Medicaid |
$2,015.09
|
| Rate for Payer: AlohaCare Medicare |
$1,914.76
|
| Rate for Payer: Cash Price |
$2,068.20
|
| Rate for Payer: Cash Price |
$2,068.20
|
| Rate for Payer: Devoted Health Medicare |
$2,106.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,914.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,432.08
|
| Rate for Payer: Health Management Network Commercial |
$2,929.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,297.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,297.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,297.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,015.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,914.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,015.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,914.76
|
|
|
PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 36825
|
| Min. Negotiated Rate |
$606.58 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: AlohaCare Medicaid |
$752.55
|
| Rate for Payer: AlohaCare Medicare |
$690.52
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Devoted Health Medicare |
$759.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$690.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.58
|
| Rate for Payer: Health Management Network Commercial |
$1,088.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$828.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$828.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$828.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$752.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$690.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$752.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$690.52
|
|
|
PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 36830
|
| Min. Negotiated Rate |
$580.83 |
| Max. Negotiated Rate |
$914.60 |
| Rate for Payer: AlohaCare Medicaid |
$631.08
|
| Rate for Payer: AlohaCare Medicare |
$580.83
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Devoted Health Medicare |
$638.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$851.50
|
| Rate for Payer: Health Management Network Commercial |
$914.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$697.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$697.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$697.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$631.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$631.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.83
|
|
|
PR CSTO W/TRURL RESCJ/INC EJACULATORY DUXS
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 52402
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: AlohaCare Medicaid |
$260.05
|
| Rate for Payer: AlohaCare Medicare |
$226.79
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Devoted Health Medicare |
$249.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.79
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.79
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Professional
|
Both
|
$758.78
|
|
|
Service Code
|
HCPCS 30905
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: AlohaCare Medicaid |
$104.24
|
| Rate for Payer: AlohaCare Medicare |
$96.74
|
| Rate for Payer: Cash Price |
$455.27
|
| Rate for Payer: Cash Price |
$455.27
|
| Rate for Payer: Devoted Health Medicare |
$106.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$174.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$104.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$644.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.74
|
| Rate for Payer: University Health Alliance Commercial |
$137.72
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$776.98
|
|
|
Service Code
|
HCPCS 30906
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$660.43 |
| Rate for Payer: AlohaCare Medicaid |
$131.48
|
| Rate for Payer: AlohaCare Medicare |
$116.63
|
| Rate for Payer: Cash Price |
$466.19
|
| Rate for Payer: Cash Price |
$466.19
|
| Rate for Payer: Devoted Health Medicare |
$128.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$226.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$660.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.63
|
| Rate for Payer: University Health Alliance Commercial |
$178.60
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
HCPCS 42961
|
| Min. Negotiated Rate |
$230.36 |
| Max. Negotiated Rate |
$639.20 |
| Rate for Payer: AlohaCare Medicaid |
$441.25
|
| Rate for Payer: AlohaCare Medicare |
$382.78
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Devoted Health Medicare |
$421.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$382.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.36
|
| Rate for Payer: Health Management Network Commercial |
$639.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$459.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$459.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$382.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$441.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$382.78
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 42962
|
| Min. Negotiated Rate |
$301.08 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: AlohaCare Medicaid |
$540.92
|
| Rate for Payer: AlohaCare Medicare |
$467.87
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Devoted Health Medicare |
$514.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$467.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.08
|
| Rate for Payer: Health Management Network Commercial |
$784.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$561.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$561.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$561.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$540.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$467.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$540.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$467.87
|
|
|
PR CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 59160
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: AlohaCare Medicaid |
$188.45
|
| Rate for Payer: AlohaCare Medicare |
$162.12
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Devoted Health Medicare |
$178.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$188.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$188.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$231.40
|
| Rate for Payer: Health Management Network Commercial |
$405.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.12
|
| Rate for Payer: University Health Alliance Commercial |
$250.65
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$24.60
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: AlohaCare Medicaid |
$14.00
|
| Rate for Payer: AlohaCare Medicare |
$14.06
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Devoted Health Medicare |
$15.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.25
|
| Rate for Payer: Health Management Network Commercial |
$20.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.06
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$71.23 |
| Rate for Payer: AlohaCare Medicaid |
$42.83
|
| Rate for Payer: AlohaCare Medicare |
$44.06
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Devoted Health Medicare |
$48.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.23
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.06
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$37.36
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$31.76 |
| Rate for Payer: AlohaCare Medicaid |
$21.29
|
| Rate for Payer: AlohaCare Medicare |
$21.35
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Devoted Health Medicare |
$23.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$31.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.35
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$139.06
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$78.11
|
| Rate for Payer: AlohaCare Medicare |
$79.46
|
| Rate for Payer: Cash Price |
$83.44
|
| Rate for Payer: Cash Price |
$83.44
|
| Rate for Payer: Devoted Health Medicare |
$87.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.19
|
| Rate for Payer: Health Management Network Commercial |
$118.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.46
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$951.60 |
| Max. Negotiated Rate |
$1,670.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,260.38
|
| Rate for Payer: AlohaCare Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Devoted Health Medicare |
$1,234.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,122.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network Commercial |
$1,670.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,347.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,347.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,347.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,260.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,122.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,260.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,122.62
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$750.88 |
| Max. Negotiated Rate |
$1,290.30 |
| Rate for Payer: AlohaCare Medicaid |
$967.18
|
| Rate for Payer: AlohaCare Medicare |
$867.53
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Devoted Health Medicare |
$954.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$867.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$750.88
|
| Rate for Payer: Health Management Network Commercial |
$1,290.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,041.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,041.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,041.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$967.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$867.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$967.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$867.53
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$584.87
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$497.14 |
| Rate for Payer: AlohaCare Medicaid |
$151.82
|
| Rate for Payer: AlohaCare Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Devoted Health Medicare |
$149.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$252.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.44
|
| Rate for Payer: Health Management Network Commercial |
$497.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.35
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$278.15 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: AlohaCare Medicaid |
$315.30
|
| Rate for Payer: AlohaCare Medicare |
$278.15
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Devoted Health Medicare |
$305.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.76
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$315.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$315.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.15
|
|
