|
PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
HCPCS 44021
|
| Min. Negotiated Rate |
$562.12 |
| Max. Negotiated Rate |
$1,396.55 |
| Rate for Payer: AlohaCare Medicaid |
$955.36
|
| Rate for Payer: AlohaCare Medicare |
$886.79
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Devoted Health Medicare |
$975.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$886.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$562.12
|
| Rate for Payer: Health Management Network Commercial |
$1,396.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,064.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,064.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,064.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$955.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$886.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$955.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$886.79
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 44020
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$1,399.10 |
| Rate for Payer: AlohaCare Medicaid |
$958.67
|
| Rate for Payer: AlohaCare Medicare |
$893.11
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Cash Price |
$987.60
|
| Rate for Payer: Devoted Health Medicare |
$982.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$580.58
|
| Rate for Payer: Health Management Network Commercial |
$1,399.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,071.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$958.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$958.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.11
|
|
|
PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$703.04 |
| Max. Negotiated Rate |
$1,743.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,197.17
|
| Rate for Payer: AlohaCare Medicare |
$1,104.03
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Devoted Health Medicare |
$1,214.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$703.04
|
| Rate for Payer: Health Management Network Commercial |
$1,743.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,324.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,324.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,324.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,197.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,197.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.03
|
|
|
PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN
|
Professional
|
Both
|
$518.32
|
|
|
Service Code
|
HCPCS 93641 26
|
| Min. Negotiated Rate |
$296.18 |
| Max. Negotiated Rate |
$570.23 |
| Rate for Payer: AlohaCare Medicaid |
$547.26
|
| Rate for Payer: AlohaCare Medicare |
$296.18
|
| Rate for Payer: Cash Price |
$310.99
|
| Rate for Payer: Cash Price |
$310.99
|
| Rate for Payer: Devoted Health Medicare |
$325.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.23
|
| Rate for Payer: Health Management Network Commercial |
$440.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$547.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$547.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.18
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$603.96 |
| Max. Negotiated Rate |
$949.45 |
| Rate for Payer: AlohaCare Medicaid |
$650.02
|
| Rate for Payer: AlohaCare Medicare |
$603.96
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Devoted Health Medicare |
$664.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$603.96
|
| Rate for Payer: Health Management Network Commercial |
$949.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$724.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$724.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$724.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$603.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$650.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$603.96
|
|
|
PREP IRRISEPT ISEPT-450-USA
|
Facility
|
IP
|
$493.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.05 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
|
|
PREP IRRISEPT ISEPT-450-USA
|
Facility
|
OP
|
$493.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.35
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$310.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.43
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
| Rate for Payer: University Health Alliance Commercial |
$359.35
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: AlohaCare Medicaid |
$375.62
|
| Rate for Payer: AlohaCare Medicare |
$330.44
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Devoted Health Medicare |
$363.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$421.98
|
| Rate for Payer: Health Management Network Commercial |
$544.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.44
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$418.90 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: AlohaCare Medicaid |
$477.37
|
| Rate for Payer: AlohaCare Medicare |
$418.90
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Devoted Health Medicare |
$460.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$418.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$528.58
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$502.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$502.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$502.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$477.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.90
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: AlohaCare Medicaid |
$429.54
|
| Rate for Payer: AlohaCare Medicare |
$376.79
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Devoted Health Medicare |
$414.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$432.12
|
| Rate for Payer: Health Management Network Commercial |
$621.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$452.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$452.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$429.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.79
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: AlohaCare Medicaid |
$320.63
|
| Rate for Payer: AlohaCare Medicare |
$281.75
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Devoted Health Medicare |
$309.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$428.22
|
| Rate for Payer: Health Management Network Commercial |
$464.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$338.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$320.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.75
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$638.82 |
| Rate for Payer: AlohaCare Medicaid |
$361.48
|
| Rate for Payer: AlohaCare Medicare |
$317.80
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Devoted Health Medicare |
$349.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$638.82
|
| Rate for Payer: Health Management Network Commercial |
$523.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$381.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$381.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$381.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$361.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$361.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.80
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$328.53 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: AlohaCare Medicaid |
$373.52
|
| Rate for Payer: AlohaCare Medicare |
$328.53
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Devoted Health Medicare |
$361.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$419.38
|
| Rate for Payer: Health Management Network Commercial |
$540.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$373.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.53
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$402.25 |
| Max. Negotiated Rate |
$663.85 |
| Rate for Payer: AlohaCare Medicaid |
$458.52
|
| Rate for Payer: AlohaCare Medicare |
$402.25
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Devoted Health Medicare |
$442.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$508.30
|
| Rate for Payer: Health Management Network Commercial |
$663.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$458.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$458.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.25
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$376.46 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: AlohaCare Medicaid |
$429.39
|
| Rate for Payer: AlohaCare Medicare |
$376.46
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Devoted Health Medicare |
$414.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$479.44
|
| Rate for Payer: Health Management Network Commercial |
$621.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$429.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.46
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$296.15 |
| Max. Negotiated Rate |
$487.05 |
| Rate for Payer: AlohaCare Medicaid |
$336.34
|
| Rate for Payer: AlohaCare Medicare |
$296.15
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Devoted Health Medicare |
$325.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$335.14
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$336.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$336.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.15
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$312.65 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: AlohaCare Medicaid |
$355.05
|
| Rate for Payer: AlohaCare Medicare |
$312.65
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Devoted Health Medicare |
$343.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$312.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$328.90
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$355.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$312.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$355.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$312.65
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$311.89 |
| Max. Negotiated Rate |
$556.14 |
| Rate for Payer: AlohaCare Medicaid |
$354.48
|
| Rate for Payer: AlohaCare Medicare |
$311.89
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Devoted Health Medicare |
$343.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.14
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$374.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$374.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$374.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.89
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: AlohaCare Medicaid |
$79.81
|
| Rate for Payer: AlohaCare Medicare |
$70.16
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$77.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.16
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.16
|
|
|
PR ESCHAROTOMY FIRST INCISION
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$174.36 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: AlohaCare Medicaid |
$192.69
|
| Rate for Payer: AlohaCare Medicare |
$174.36
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Devoted Health Medicare |
$191.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.38
|
| Rate for Payer: Health Management Network Commercial |
$280.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$192.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.36
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: AlohaCare Medicaid |
$245.67
|
| Rate for Payer: AlohaCare Medicare |
$272.11
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Devoted Health Medicare |
$299.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.61
|
| Rate for Payer: Health Management Network Commercial |
$579.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$326.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$245.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.11
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 91010 TC
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: AlohaCare Medicaid |
$245.67
|
| Rate for Payer: AlohaCare Medicare |
$202.04
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Devoted Health Medicare |
$222.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.61
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$245.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.04
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 91010 26
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$245.67 |
| Rate for Payer: AlohaCare Medicaid |
$245.67
|
| Rate for Payer: AlohaCare Medicare |
$70.07
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Devoted Health Medicare |
$77.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.61
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$245.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.07
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$861.10
|
|
|
Service Code
|
HCPCS 43236
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$731.93 |
| Rate for Payer: AlohaCare Medicaid |
$139.09
|
| Rate for Payer: AlohaCare Medicare |
$124.82
|
| Rate for Payer: Cash Price |
$516.66
|
| Rate for Payer: Cash Price |
$516.66
|
| Rate for Payer: Devoted Health Medicare |
$137.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$287.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.30
|
| Rate for Payer: Health Management Network Commercial |
$731.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.82
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$618.50
|
|
|
Service Code
|
HCPCS 43235
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$525.73 |
| Rate for Payer: AlohaCare Medicaid |
$123.38
|
| Rate for Payer: AlohaCare Medicare |
$111.90
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Devoted Health Medicare |
$123.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$232.96
|
| Rate for Payer: Health Management Network Commercial |
$525.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.90
|
|
