|
PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 99606
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99605
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 90734
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.47
|
| Rate for Payer: Health Management Network Commercial |
$595.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 90619
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
|
|
PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 90620
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$193.50
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
|
|
PR MENIGCCAL PNTVLNT MENACWY TT MENB FHBP VACC IM
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 90623
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
|
|
PR METACARP FX ORTHOSIS PRE OTS
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS L3918
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$88.51
|
| Rate for Payer: AlohaCare Medicare |
$115.37
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$126.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.77
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.37
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,033.08
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$368.16 |
| Max. Negotiated Rate |
$878.12 |
| Rate for Payer: AlohaCare Medicaid |
$437.48
|
| Rate for Payer: AlohaCare Medicare |
$401.97
|
| Rate for Payer: Cash Price |
$619.85
|
| Rate for Payer: Cash Price |
$619.85
|
| Rate for Payer: Devoted Health Medicare |
$442.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$437.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$730.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$437.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$368.16
|
| Rate for Payer: Health Management Network Commercial |
$878.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$437.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.97
|
| Rate for Payer: University Health Alliance Commercial |
$575.70
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$5,006.00
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$1,322.10 |
| Max. Negotiated Rate |
$4,255.10 |
| Rate for Payer: AlohaCare Medicaid |
$2,922.09
|
| Rate for Payer: AlohaCare Medicare |
$2,671.86
|
| Rate for Payer: Cash Price |
$3,003.60
|
| Rate for Payer: Cash Price |
$3,003.60
|
| Rate for Payer: Devoted Health Medicare |
$2,939.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,671.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,322.10
|
| Rate for Payer: Health Management Network Commercial |
$4,255.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,206.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,206.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,206.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,922.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,671.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,922.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,671.86
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$183.88 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: AlohaCare Medicaid |
$204.81
|
| Rate for Payer: AlohaCare Medicare |
$183.88
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Devoted Health Medicare |
$202.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.72
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$220.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.88
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$1,058.25 |
| Rate for Payer: AlohaCare Medicaid |
$740.15
|
| Rate for Payer: AlohaCare Medicare |
$654.69
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Devoted Health Medicare |
$720.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$654.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$785.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$785.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$785.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$654.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$654.69
|
|
|
PR MIFEPRISTONE, ORAL, 200 MG
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS S0190
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: AlohaCare Medicaid |
$81.05
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.05
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: AlohaCare Medicaid |
$2.36
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.36
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: AlohaCare Medicaid |
$205.42
|
| Rate for Payer: AlohaCare Medicare |
$189.39
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Devoted Health Medicare |
$208.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.39
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$102.46 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$115.31
|
| Rate for Payer: AlohaCare Medicare |
$102.46
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$112.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.46
|
|
|
PR MOD SEDAT ENDO SERVICE >5YRS
|
Professional
|
Both
|
$131.15
|
|
|
Service Code
|
HCPCS G0500
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$111.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.42
|
| Rate for Payer: AlohaCare Medicare |
$5.06
|
| Rate for Payer: Cash Price |
$78.69
|
| Rate for Payer: Cash Price |
$78.69
|
| Rate for Payer: Devoted Health Medicare |
$5.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.40
|
| Rate for Payer: Health Management Network Commercial |
$111.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.06
|
| Rate for Payer: University Health Alliance Commercial |
$5.27
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Devoted Health Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.64
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$118.63
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: AlohaCare Medicaid |
$24.09
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$71.18
|
| Rate for Payer: Cash Price |
$71.18
|
| Rate for Payer: Devoted Health Medicare |
$23.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.60
|
| Rate for Payer: Health Management Network Commercial |
$100.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$30.08
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$99.36
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: AlohaCare Medicaid |
$11.94
|
| Rate for Payer: AlohaCare Medicare |
$10.83
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Devoted Health Medicare |
$11.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.30
|
| Rate for Payer: Health Management Network Commercial |
$84.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.83
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 95905 TC
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$34.75
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.75
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 95905 26
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$2.62
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$2.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.62
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$37.38
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Devoted Health Medicare |
$41.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.38
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$74.39
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: AlohaCare Medicaid |
$30.19
|
| Rate for Payer: AlohaCare Medicare |
$30.74
|
| Rate for Payer: Cash Price |
$44.63
|
| Rate for Payer: Cash Price |
$44.63
|
| Rate for Payer: Devoted Health Medicare |
$33.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.19
|
| Rate for Payer: Health Management Network Commercial |
$63.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.74
|
| Rate for Payer: University Health Alliance Commercial |
$33.81
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$924.30 |
| Max. Negotiated Rate |
$1,867.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,286.55
|
| Rate for Payer: AlohaCare Medicare |
$1,153.25
|
| Rate for Payer: Cash Price |
$1,318.20
|
| Rate for Payer: Cash Price |
$1,318.20
|
| Rate for Payer: Devoted Health Medicare |
$1,268.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,153.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$924.30
|
| Rate for Payer: Health Management Network Commercial |
$1,867.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,383.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,383.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,383.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,286.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,153.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,286.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,153.25
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$2,590.00
|
|
|
Service Code
|
HCPCS 15734
|
| Min. Negotiated Rate |
$1,381.34 |
| Max. Negotiated Rate |
$2,201.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,509.96
|
| Rate for Payer: AlohaCare Medicare |
$1,381.34
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Devoted Health Medicare |
$1,519.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,381.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,406.86
|
| Rate for Payer: Health Management Network Commercial |
$2,201.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,657.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,657.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,657.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,509.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,381.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,509.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,381.34
|
|
