|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$675.18 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: AlohaCare Medicaid |
$776.41
|
| Rate for Payer: AlohaCare Medicare |
$675.18
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Devoted Health Medicare |
$742.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$675.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$747.25
|
| Rate for Payer: Health Management Network Commercial |
$1,116.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$776.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$776.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$675.18
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$474.74 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$558.03
|
| Rate for Payer: AlohaCare Medicare |
$474.74
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$522.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$474.74
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$569.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$569.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$569.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$558.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$474.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$558.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$474.74
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$321.21
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: AlohaCare Medicare |
$114.81
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Devoted Health Medicare |
$126.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.94
|
| Rate for Payer: Health Management Network Commercial |
$273.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.81
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: AlohaCare Medicaid |
$73.80
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.80
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: AlohaCare Medicaid |
$114.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.60
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: AlohaCare Medicaid |
$123.12
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$121.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.17
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.12
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$75.41 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: AlohaCare Medicaid |
$98.65
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.41
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.65
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AlohaCare Medicaid |
$78.84
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$77.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$77.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.67
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.84
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: AlohaCare Medicaid |
$94.46
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$211.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.46
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$67.77 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: AlohaCare Medicaid |
$83.70
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.77
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.70
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$111.51
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$94.78 |
| Rate for Payer: AlohaCare Medicaid |
$38.69
|
| Rate for Payer: AlohaCare Medicare |
$32.96
|
| Rate for Payer: Cash Price |
$66.91
|
| Rate for Payer: Cash Price |
$66.91
|
| Rate for Payer: Devoted Health Medicare |
$36.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$65.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$94.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.96
|
| Rate for Payer: University Health Alliance Commercial |
$48.22
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$451.78
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$384.01 |
| Rate for Payer: AlohaCare Medicaid |
$83.43
|
| Rate for Payer: AlohaCare Medicare |
$73.97
|
| Rate for Payer: Cash Price |
$271.07
|
| Rate for Payer: Cash Price |
$271.07
|
| Rate for Payer: Devoted Health Medicare |
$81.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$139.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.46
|
| Rate for Payer: Health Management Network Commercial |
$384.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.97
|
| Rate for Payer: University Health Alliance Commercial |
$110.69
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$142.62
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: AlohaCare Medicaid |
$51.46
|
| Rate for Payer: AlohaCare Medicare |
$44.28
|
| Rate for Payer: Cash Price |
$85.57
|
| Rate for Payer: Cash Price |
$85.57
|
| Rate for Payer: Devoted Health Medicare |
$48.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$103.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.98
|
| Rate for Payer: Health Management Network Commercial |
$121.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.28
|
| Rate for Payer: University Health Alliance Commercial |
$63.98
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$229.79
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$195.32 |
| Rate for Payer: AlohaCare Medicaid |
$55.04
|
| Rate for Payer: AlohaCare Medicare |
$50.42
|
| Rate for Payer: Cash Price |
$137.87
|
| Rate for Payer: Cash Price |
$137.87
|
| Rate for Payer: Devoted Health Medicare |
$55.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.94
|
| Rate for Payer: Health Management Network Commercial |
$195.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.42
|
| Rate for Payer: University Health Alliance Commercial |
$68.40
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$464.75
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$73.03 |
| Max. Negotiated Rate |
$395.04 |
| Rate for Payer: AlohaCare Medicaid |
$82.66
|
| Rate for Payer: AlohaCare Medicare |
$73.03
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Devoted Health Medicare |
$80.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.12
|
| Rate for Payer: Health Management Network Commercial |
$395.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.03
|
| Rate for Payer: University Health Alliance Commercial |
$103.19
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$152.71
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$129.80 |
| Rate for Payer: AlohaCare Medicaid |
$42.33
|
| Rate for Payer: AlohaCare Medicare |
$39.03
|
| Rate for Payer: Cash Price |
$91.63
|
| Rate for Payer: Cash Price |
$91.63
|
| Rate for Payer: Devoted Health Medicare |
$42.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$129.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.03
|
| Rate for Payer: University Health Alliance Commercial |
$52.25
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$179.30
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$48.91 |
| Max. Negotiated Rate |
$152.41 |
| Rate for Payer: AlohaCare Medicaid |
$55.03
|
| Rate for Payer: AlohaCare Medicare |
$48.91
|
| Rate for Payer: Cash Price |
$107.58
|
| Rate for Payer: Cash Price |
$107.58
|
| Rate for Payer: Devoted Health Medicare |
$53.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.02
|
| Rate for Payer: Health Management Network Commercial |
$152.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.91
|
| Rate for Payer: University Health Alliance Commercial |
$68.62
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$467.36
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$397.26 |
| Rate for Payer: AlohaCare Medicaid |
$87.91
|
| Rate for Payer: AlohaCare Medicare |
$79.07
|
| Rate for Payer: Cash Price |
$280.42
|
| Rate for Payer: Cash Price |
$280.42
|
| Rate for Payer: Devoted Health Medicare |
$86.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$140.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.96
|
| Rate for Payer: Health Management Network Commercial |
$397.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.07
|
| Rate for Payer: University Health Alliance Commercial |
$108.95
|
|
|
PR INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 64517
|
| Min. Negotiated Rate |
$115.94 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: AlohaCare Medicaid |
$129.18
|
| Rate for Payer: AlohaCare Medicare |
$115.94
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Devoted Health Medicare |
$127.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.68
|
| Rate for Payer: Health Management Network Commercial |
$323.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.94
|
| Rate for Payer: University Health Alliance Commercial |
$161.06
|
|
|
PR INJECTION CORPORA CAVERNOSA PHARMACOLOGIC AGENT
|
Professional
|
Both
|
$174.56
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$148.38 |
| Rate for Payer: AlohaCare Medicare |
$69.37
|
| Rate for Payer: Cash Price |
$104.74
|
| Rate for Payer: Cash Price |
$104.74
|
| Rate for Payer: Devoted Health Medicare |
$76.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$122.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$148.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.37
|
| Rate for Payer: University Health Alliance Commercial |
$94.58
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$173.37
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$58.43 |
| Max. Negotiated Rate |
$147.36 |
| Rate for Payer: AlohaCare Medicaid |
$66.67
|
| Rate for Payer: AlohaCare Medicare |
$58.43
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Cash Price |
$104.02
|
| Rate for Payer: Devoted Health Medicare |
$64.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$110.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.67
|
| Rate for Payer: Health Management Network Commercial |
$147.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.43
|
| Rate for Payer: University Health Alliance Commercial |
$83.46
|
|
|
PR INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA
|
Professional
|
Both
|
$447.49
|
|
|
Service Code
|
HCPCS 27093
|
| Min. Negotiated Rate |
$57.09 |
| Max. Negotiated Rate |
$380.37 |
| Rate for Payer: AlohaCare Medicaid |
$67.49
|
| Rate for Payer: AlohaCare Medicare |
$57.09
|
| Rate for Payer: Cash Price |
$268.49
|
| Rate for Payer: Cash Price |
$268.49
|
| Rate for Payer: Devoted Health Medicare |
$62.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$113.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.46
|
| Rate for Payer: Health Management Network Commercial |
$380.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.09
|
| Rate for Payer: University Health Alliance Commercial |
$93.66
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$128.38
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: AlohaCare Medicaid |
$46.10
|
| Rate for Payer: AlohaCare Medicare |
$36.52
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: Devoted Health Medicare |
$40.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.10
|
| Rate for Payer: Health Management Network Commercial |
$109.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.52
|
| Rate for Payer: University Health Alliance Commercial |
$53.12
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$107.26
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$91.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.29
|
| Rate for Payer: AlohaCare Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$64.36
|
| Rate for Payer: Cash Price |
$64.36
|
| Rate for Payer: Devoted Health Medicare |
$26.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.24
|
| Rate for Payer: Health Management Network Commercial |
$91.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.08
|
| Rate for Payer: University Health Alliance Commercial |
$32.47
|
|
|
PR INJECTION PROCEDURE LYMPHANGIOGRAPHY
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 38790
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$83.01
|
| Rate for Payer: AlohaCare Medicare |
$76.71
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$84.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.58
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.71
|
|
