|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 92242
|
| Min. Negotiated Rate |
$259.30 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: AlohaCare Medicaid |
$316.93
|
| Rate for Payer: AlohaCare Medicare |
$377.43
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Devoted Health Medicare |
$415.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$377.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.30
|
| Rate for Payer: Health Management Network Commercial |
$944.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$452.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$452.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$377.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$377.43
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$129.27
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.34
|
| Rate for Payer: AlohaCare Medicare |
$49.56
|
| Rate for Payer: Cash Price |
$77.56
|
| Rate for Payer: Cash Price |
$77.56
|
| Rate for Payer: Devoted Health Medicare |
$54.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$109.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.56
|
| Rate for Payer: University Health Alliance Commercial |
$73.88
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: AlohaCare Medicaid |
$127.09
|
| Rate for Payer: AlohaCare Medicare |
$114.59
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Devoted Health Medicare |
$126.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.98
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.59
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$683.27
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: AlohaCare Medicaid |
$269.20
|
| Rate for Payer: AlohaCare Medicare |
$241.96
|
| Rate for Payer: Cash Price |
$409.96
|
| Rate for Payer: Cash Price |
$409.96
|
| Rate for Payer: Devoted Health Medicare |
$266.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$269.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$441.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$269.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.36
|
| Rate for Payer: Health Management Network Commercial |
$580.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.96
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: AlohaCare Medicaid |
$203.67
|
| Rate for Payer: AlohaCare Medicare |
$191.48
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Devoted Health Medicare |
$210.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.36
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.48
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,740.20
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$1,479.17 |
| Rate for Payer: AlohaCare Medicaid |
$835.06
|
| Rate for Payer: AlohaCare Medicare |
$722.48
|
| Rate for Payer: Cash Price |
$1,044.12
|
| Rate for Payer: Cash Price |
$1,044.12
|
| Rate for Payer: Devoted Health Medicare |
$794.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$835.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,369.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$722.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$835.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.84
|
| Rate for Payer: Health Management Network Commercial |
$1,479.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$866.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$866.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$866.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$835.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$722.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$835.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$722.48
|
| Rate for Payer: University Health Alliance Commercial |
$942.38
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,857.85
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$1,579.17 |
| Rate for Payer: AlohaCare Medicaid |
$884.63
|
| Rate for Payer: AlohaCare Medicare |
$750.78
|
| Rate for Payer: Cash Price |
$1,114.71
|
| Rate for Payer: Cash Price |
$1,114.71
|
| Rate for Payer: Devoted Health Medicare |
$825.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$884.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,451.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$884.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$686.40
|
| Rate for Payer: Health Management Network Commercial |
$1,579.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$900.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$900.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$884.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$884.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.78
|
| Rate for Payer: University Health Alliance Commercial |
$999.09
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,458.10
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$398.58 |
| Max. Negotiated Rate |
$1,239.38 |
| Rate for Payer: AlohaCare Medicaid |
$638.04
|
| Rate for Payer: AlohaCare Medicare |
$554.45
|
| Rate for Payer: Cash Price |
$874.86
|
| Rate for Payer: Cash Price |
$874.86
|
| Rate for Payer: Devoted Health Medicare |
$609.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$638.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,048.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$554.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$638.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.58
|
| Rate for Payer: Health Management Network Commercial |
$1,239.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$665.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$665.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$638.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$554.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$638.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$554.45
|
| Rate for Payer: University Health Alliance Commercial |
$721.56
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,622.22
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$381.42 |
| Max. Negotiated Rate |
$1,378.89 |
| Rate for Payer: AlohaCare Medicaid |
$696.83
|
| Rate for Payer: AlohaCare Medicare |
$619.37
|
| Rate for Payer: Cash Price |
$973.33
|
| Rate for Payer: Cash Price |
$973.33
|
| Rate for Payer: Devoted Health Medicare |
$681.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$696.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,151.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$619.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$696.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$381.42
|
| Rate for Payer: Health Management Network Commercial |
$1,378.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$743.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$743.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$743.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$619.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$696.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$619.37
|
| Rate for Payer: University Health Alliance Commercial |
$792.41
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$333.60
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$88.09 |
| Max. Negotiated Rate |
$283.56 |
| Rate for Payer: AlohaCare Medicaid |
$106.33
|
| Rate for Payer: AlohaCare Medicare |
$88.09
|
| Rate for Payer: Cash Price |
$200.16
|
| Rate for Payer: Cash Price |
$200.16
|
| Rate for Payer: Devoted Health Medicare |
$96.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.66
|
| Rate for Payer: Health Management Network Commercial |
$283.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.09
|
| Rate for Payer: University Health Alliance Commercial |
$121.13
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$250.69
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$213.09 |
| Rate for Payer: AlohaCare Medicaid |
$68.39
|
| Rate for Payer: AlohaCare Medicare |
$56.66
|
| Rate for Payer: Cash Price |
$150.41
|
| Rate for Payer: Cash Price |
$150.41
|
| Rate for Payer: Devoted Health Medicare |
$62.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$115.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$213.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.66
|
| Rate for Payer: University Health Alliance Commercial |
$79.45
|
|
|
PR FTH/GFT FR W/DIR CLSR TRUNK EA ADDL 20 SQ CM
|
Professional
|
Both
|
$277.25
|
|
|
Service Code
|
HCPCS 15201
|
| Min. Negotiated Rate |
$63.49 |
| Max. Negotiated Rate |
$235.66 |
| Rate for Payer: AlohaCare Medicaid |
$75.38
|
| Rate for Payer: AlohaCare Medicare |
$63.49
|
| Rate for Payer: Cash Price |
$166.35
|
| Rate for Payer: Cash Price |
$166.35
|
| Rate for Payer: Devoted Health Medicare |
$69.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$126.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.04
|
| Rate for Payer: Health Management Network Commercial |
$235.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.49
|
| Rate for Payer: University Health Alliance Commercial |
$87.11
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$170.61
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Devoted Health Medicare |
$187.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$423.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.61
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 93304 26
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$35.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$39.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.78
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$134.82
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Devoted Health Medicare |
$148.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.82
|
|
|
PR FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 26820
|
| Min. Negotiated Rate |
$496.34 |
| Max. Negotiated Rate |
$1,282.65 |
| Rate for Payer: AlohaCare Medicaid |
$889.21
|
| Rate for Payer: AlohaCare Medicare |
$855.17
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Devoted Health Medicare |
$940.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$855.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$496.34
|
| Rate for Payer: Health Management Network Commercial |
$1,282.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,026.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,026.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,026.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$889.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$855.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$889.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$855.17
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727 TC
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$42.73
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Devoted Health Medicare |
$47.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.73
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$55.07
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$60.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.07
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 94727 26
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$12.34
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.34
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 91034 TC
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$172.42
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Devoted Health Medicare |
$189.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$435.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.42
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 91034 26
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$238.29 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$51.88
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$57.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.88
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$512.55 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$224.30
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Devoted Health Medicare |
$246.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.30
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 91037 26
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$53.21
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$58.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.21
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.21
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$207.40
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$228.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.40
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.40
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 91037 TC
|
| Min. Negotiated Rate |
$154.19 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$154.19
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$169.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.19
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.19
|
|
