|
PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,363.00
|
|
|
Service Code
|
HCPCS 50947
|
| Min. Negotiated Rate |
$1,225.95 |
| Max. Negotiated Rate |
$2,008.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,381.47
|
| Rate for Payer: AlohaCare Medicare |
$1,225.95
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Devoted Health Medicare |
$1,348.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,225.95
|
| Rate for Payer: Health Management Network Commercial |
$2,008.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,471.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,471.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,471.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,381.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,225.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,381.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,225.95
|
|
|
PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 58554
|
| Min. Negotiated Rate |
$1,037.40 |
| Max. Negotiated Rate |
$1,892.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,310.83
|
| Rate for Payer: AlohaCare Medicare |
$1,140.95
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Devoted Health Medicare |
$1,255.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,140.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,037.40
|
| Rate for Payer: Health Management Network Commercial |
$1,892.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,369.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,369.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,369.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,310.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,140.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,310.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,140.95
|
|
|
PR LAPS W/REVISION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 49325
|
| Min. Negotiated Rate |
$379.38 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: AlohaCare Medicaid |
$406.78
|
| Rate for Payer: AlohaCare Medicare |
$379.38
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Devoted Health Medicare |
$417.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.06
|
| Rate for Payer: Health Management Network Commercial |
$590.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$455.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$455.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$406.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.38
|
|
|
PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 58552
|
| Min. Negotiated Rate |
$765.70 |
| Max. Negotiated Rate |
$1,433.95 |
| Rate for Payer: AlohaCare Medicaid |
$990.56
|
| Rate for Payer: AlohaCare Medicare |
$865.91
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Devoted Health Medicare |
$952.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$865.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$765.70
|
| Rate for Payer: Health Management Network Commercial |
$1,433.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,039.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,039.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,039.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$990.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$865.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$990.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$865.91
|
|
|
PR LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 31541
|
| Min. Negotiated Rate |
$221.96 |
| Max. Negotiated Rate |
$383.35 |
| Rate for Payer: AlohaCare Medicaid |
$264.14
|
| Rate for Payer: AlohaCare Medicare |
$221.96
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Devoted Health Medicare |
$244.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$351.78
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.96
|
|
|
PR LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 31571
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$363.80 |
| Rate for Payer: AlohaCare Medicaid |
$250.15
|
| Rate for Payer: AlohaCare Medicare |
$210.22
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Devoted Health Medicare |
$231.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$210.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$250.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$250.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.22
|
|
|
PR LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 31535
|
| Min. Negotiated Rate |
$161.71 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$191.04
|
| Rate for Payer: AlohaCare Medicare |
$161.71
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Devoted Health Medicare |
$177.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.72
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.71
|
|
|
PR LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 31540
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: AlohaCare Medicaid |
$242.44
|
| Rate for Payer: AlohaCare Medicare |
$204.35
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Devoted Health Medicare |
$224.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.46
|
| Rate for Payer: Health Management Network Commercial |
$352.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.35
|
|
|
PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC
|
Professional
|
Both
|
$241.60
|
|
|
Service Code
|
HCPCS 31575
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: AlohaCare Medicaid |
$71.39
|
| Rate for Payer: AlohaCare Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$144.96
|
| Rate for Payer: Cash Price |
$144.96
|
| Rate for Payer: Devoted Health Medicare |
$69.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$115.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.98
|
| Rate for Payer: Health Management Network Commercial |
$205.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.86
|
| Rate for Payer: University Health Alliance Commercial |
$89.27
|
|
|
PR LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES)
|
Professional
|
Both
|
$511.12
|
|
|
Service Code
|
HCPCS 31576
|
| Min. Negotiated Rate |
$104.84 |
| Max. Negotiated Rate |
$434.45 |
| Rate for Payer: AlohaCare Medicaid |
$122.27
|
| Rate for Payer: AlohaCare Medicare |
$104.84
|
| Rate for Payer: Cash Price |
$306.67
|
| Rate for Payer: Cash Price |
$306.67
|
| Rate for Payer: Devoted Health Medicare |
$115.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$434.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.84
|
| Rate for Payer: University Health Alliance Commercial |
$158.13
|
|
|
PR LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31574
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$1,499.40 |
| Rate for Payer: AlohaCare Medicaid |
$151.87
|
| Rate for Payer: AlohaCare Medicare |
$129.42
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Devoted Health Medicare |
$142.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$250.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.87
|
| Rate for Payer: Health Management Network Commercial |
$1,499.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.42
|
| Rate for Payer: University Health Alliance Commercial |
$197.32
|
|
|
PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)
|
Professional
|
Both
|
$527.38
|
|
|
Service Code
|
HCPCS 31577
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$448.27 |
| Rate for Payer: AlohaCare Medicaid |
$135.29
|
| Rate for Payer: AlohaCare Medicare |
$119.07
|
| Rate for Payer: Cash Price |
$316.43
|
| Rate for Payer: Cash Price |
$316.43
|
| Rate for Payer: Devoted Health Medicare |
$130.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.96
|
| Rate for Payer: Health Management Network Commercial |
$448.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$142.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.07
|
| Rate for Payer: University Health Alliance Commercial |
$180.25
|
|
|
PR LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Professional
|
Both
|
$169.10
|
|
|
Service Code
|
HCPCS 31505
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$143.74 |
| Rate for Payer: AlohaCare Medicaid |
$52.40
|
| Rate for Payer: AlohaCare Medicare |
$46.88
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Cash Price |
$101.46
|
| Rate for Payer: Devoted Health Medicare |
$51.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$84.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.44
|
| Rate for Payer: Health Management Network Commercial |
$143.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.88
|
| Rate for Payer: University Health Alliance Commercial |
$66.97
|
|
|
PR LARYNGOSCOPY INDIRECT W/BIOPSY
|
Professional
|
Both
|
$404.55
|
|
|
Service Code
|
HCPCS 31510
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$343.87 |
| Rate for Payer: AlohaCare Medicaid |
$124.03
|
| Rate for Payer: AlohaCare Medicare |
$106.22
|
| Rate for Payer: Cash Price |
$242.73
|
| Rate for Payer: Cash Price |
$242.73
|
| Rate for Payer: Devoted Health Medicare |
$116.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$203.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.44
|
| Rate for Payer: Health Management Network Commercial |
$343.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.22
|
| Rate for Payer: University Health Alliance Commercial |
$160.46
|
|
|
PR LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$392.68
|
|
|
Service Code
|
HCPCS 31511
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$333.78 |
| Rate for Payer: AlohaCare Medicaid |
$137.16
|
| Rate for Payer: AlohaCare Medicare |
$117.29
|
| Rate for Payer: Cash Price |
$235.61
|
| Rate for Payer: Cash Price |
$235.61
|
| Rate for Payer: Devoted Health Medicare |
$129.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$222.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$333.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.29
|
| Rate for Payer: University Health Alliance Commercial |
$175.50
|
|
|
PR LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 31536
|
| Min. Negotiated Rate |
$178.59 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: AlohaCare Medicaid |
$211.84
|
| Rate for Payer: AlohaCare Medicare |
$178.59
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Devoted Health Medicare |
$196.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$287.82
|
| Rate for Payer: Health Management Network Commercial |
$307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.59
|
|
|
PR LARYNGOSCOPY W/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 31530
|
| Min. Negotiated Rate |
$172.11 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: AlohaCare Medicaid |
$200.06
|
| Rate for Payer: AlohaCare Medicare |
$172.11
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Devoted Health Medicare |
$189.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.94
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$200.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.11
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN
|
Professional
|
Both
|
$466.88
|
|
|
Service Code
|
HCPCS 31525
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$396.85 |
| Rate for Payer: AlohaCare Medicaid |
$162.53
|
| Rate for Payer: AlohaCare Medicare |
$137.67
|
| Rate for Payer: Cash Price |
$280.13
|
| Rate for Payer: Cash Price |
$280.13
|
| Rate for Payer: Devoted Health Medicare |
$151.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$269.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$396.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$162.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.67
|
| Rate for Payer: University Health Alliance Commercial |
$201.52
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 31526
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: AlohaCare Medicaid |
$159.20
|
| Rate for Payer: AlohaCare Medicare |
$135.42
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$148.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.08
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.42
|
|
|
PR LASER ENUCLEATION PROSTATE W/MORCELLATION
|
Professional
|
Both
|
$1,431.00
|
|
|
Service Code
|
HCPCS 52649
|
| Min. Negotiated Rate |
$658.60 |
| Max. Negotiated Rate |
$1,216.35 |
| Rate for Payer: AlohaCare Medicaid |
$835.55
|
| Rate for Payer: AlohaCare Medicare |
$658.60
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Devoted Health Medicare |
$724.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$658.60
|
| Rate for Payer: Health Management Network Commercial |
$1,216.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$790.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$790.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$790.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$835.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$835.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.60
|
|
|
PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW
|
Professional
|
Both
|
$2,887.00
|
|
|
Service Code
|
HCPCS 52648
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$2,453.95 |
| Rate for Payer: AlohaCare Medicaid |
$703.06
|
| Rate for Payer: AlohaCare Medicare |
$532.28
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: Devoted Health Medicare |
$585.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$703.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,163.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$532.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$703.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$643.24
|
| Rate for Payer: Health Management Network Commercial |
$2,453.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$638.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$638.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$638.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$703.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$532.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$703.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$532.28
|
|
|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$359.57
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: AlohaCare Medicaid |
$118.85
|
| Rate for Payer: AlohaCare Medicare |
$107.87
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Devoted Health Medicare |
$118.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$191.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.32
|
| Rate for Payer: Health Management Network Commercial |
$305.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.87
|
| Rate for Payer: University Health Alliance Commercial |
$151.54
|
|
|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$347.53
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$168.59 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: AlohaCare Medicaid |
$196.64
|
| Rate for Payer: AlohaCare Medicare |
$168.59
|
| Rate for Payer: Cash Price |
$208.52
|
| Rate for Payer: Cash Price |
$208.52
|
| Rate for Payer: Devoted Health Medicare |
$185.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.59
|
| Rate for Payer: Health Management Network Commercial |
$295.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$196.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.59
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$2,731.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$959.27 |
| Max. Negotiated Rate |
$2,321.35 |
| Rate for Payer: AlohaCare Medicaid |
$974.38
|
| Rate for Payer: AlohaCare Medicare |
$959.27
|
| Rate for Payer: Cash Price |
$1,638.60
|
| Rate for Payer: Cash Price |
$1,638.60
|
| Rate for Payer: Devoted Health Medicare |
$1,055.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$959.27
|
| Rate for Payer: Health Management Network Commercial |
$2,321.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,151.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,151.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,151.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$974.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$959.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$974.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$959.27
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 93452 26
|
| Min. Negotiated Rate |
$226.87 |
| Max. Negotiated Rate |
$974.38 |
| Rate for Payer: AlohaCare Medicaid |
$974.38
|
| Rate for Payer: AlohaCare Medicare |
$226.87
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Devoted Health Medicare |
$249.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.87
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$974.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$974.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.87
|
|
