|
PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH
|
Professional
|
Both
|
$70.61
|
|
|
Service Code
|
HCPCS 93356
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: AlohaCare Medicaid |
$11.42
|
| Rate for Payer: AlohaCare Medicare |
$9.97
|
| Rate for Payer: Cash Price |
$42.37
|
| Rate for Payer: Cash Price |
$42.37
|
| Rate for Payer: Devoted Health Medicare |
$10.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.10
|
| Rate for Payer: Health Management Network Commercial |
$60.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.97
|
|
|
PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 58146
|
| Min. Negotiated Rate |
$977.86 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,160.68
|
| Rate for Payer: AlohaCare Medicare |
$998.32
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Devoted Health Medicare |
$1,098.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$998.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$977.86
|
| Rate for Payer: Health Management Network Commercial |
$1,675.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,197.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,197.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,197.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,160.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$998.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,160.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$998.32
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$1,399.93
|
|
|
Service Code
|
HCPCS 69620
|
| Min. Negotiated Rate |
$378.04 |
| Max. Negotiated Rate |
$1,189.94 |
| Rate for Payer: AlohaCare Medicaid |
$525.23
|
| Rate for Payer: AlohaCare Medicare |
$470.71
|
| Rate for Payer: Cash Price |
$839.96
|
| Rate for Payer: Cash Price |
$839.96
|
| Rate for Payer: Devoted Health Medicare |
$517.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$525.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$872.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$470.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$525.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.04
|
| Rate for Payer: Health Management Network Commercial |
$1,189.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$564.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$564.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$564.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$470.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$470.71
|
| Rate for Payer: University Health Alliance Commercial |
$650.32
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$364.14
|
|
|
Service Code
|
HCPCS 69420
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$309.52 |
| Rate for Payer: AlohaCare Medicaid |
$129.23
|
| Rate for Payer: AlohaCare Medicare |
$115.80
|
| Rate for Payer: Cash Price |
$218.48
|
| Rate for Payer: Cash Price |
$218.48
|
| Rate for Payer: Devoted Health Medicare |
$127.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$210.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$309.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.80
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 69421
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: AlohaCare Medicaid |
$161.83
|
| Rate for Payer: AlohaCare Medicare |
$144.22
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Devoted Health Medicare |
$158.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.56
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.22
|
|
|
PR NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Professional
|
Both
|
$312.62
|
|
|
Service Code
|
HCPCS 90865
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$265.73 |
| Rate for Payer: AlohaCare Medicare |
$114.84
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Devoted Health Medicare |
$126.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.59
|
| Rate for Payer: Health Management Network Commercial |
$265.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.84
|
| Rate for Payer: University Health Alliance Commercial |
$150.24
|
|
|
PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$371.02
|
|
|
Service Code
|
HCPCS 31231
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$315.37 |
| Rate for Payer: AlohaCare Medicaid |
$65.23
|
| Rate for Payer: AlohaCare Medicare |
$54.40
|
| Rate for Payer: Cash Price |
$222.61
|
| Rate for Payer: Cash Price |
$222.61
|
| Rate for Payer: Devoted Health Medicare |
$59.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$315.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.40
|
| Rate for Payer: University Health Alliance Commercial |
$80.51
|
|
|
PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$515.46
|
|
|
Service Code
|
HCPCS 31233
|
| Min. Negotiated Rate |
$117.96 |
| Max. Negotiated Rate |
$438.14 |
| Rate for Payer: AlohaCare Medicaid |
$138.21
|
| Rate for Payer: AlohaCare Medicare |
$117.96
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Devoted Health Medicare |
$129.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.92
|
| Rate for Payer: Health Management Network Commercial |
$438.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.96
|
| Rate for Payer: University Health Alliance Commercial |
$179.81
|
|
|
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 31256
|
| Min. Negotiated Rate |
$151.67 |
| Max. Negotiated Rate |
$264.35 |
| Rate for Payer: AlohaCare Medicaid |
$181.35
|
| Rate for Payer: AlohaCare Medicare |
$151.67
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Devoted Health Medicare |
$166.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$263.64
|
| Rate for Payer: Health Management Network Commercial |
$264.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.67
|
|
|
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 31287
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: AlohaCare Medicaid |
$202.34
|
| Rate for Payer: AlohaCare Medicare |
$169.13
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$186.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.20
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.13
|
|
|
PR NASAL/SINUS NDSC DSTRJ CRYOABLATION PST NSL NRV
|
Professional
|
Both
|
$4,597.77
|
|
|
Service Code
|
HCPCS 31243
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$3,908.10 |
| Rate for Payer: AlohaCare Medicaid |
$159.31
|
| Rate for Payer: AlohaCare Medicare |
$134.12
|
| Rate for Payer: Cash Price |
$2,758.66
|
| Rate for Payer: Cash Price |
$2,758.66
|
| Rate for Payer: Devoted Health Medicare |
$147.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.31
|
| Rate for Payer: Health Management Network Commercial |
$3,908.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.12
|
| Rate for Payer: University Health Alliance Commercial |
$197.32
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$497.94
|
|
|
Service Code
|
HCPCS 31237
|
| Min. Negotiated Rate |
$138.71 |
| Max. Negotiated Rate |
$423.25 |
| Rate for Payer: AlohaCare Medicaid |
$162.87
|
| Rate for Payer: AlohaCare Medicare |
$138.71
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Devoted Health Medicare |
$152.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$269.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.66
|
| Rate for Payer: Health Management Network Commercial |
$423.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$162.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.71
|
| Rate for Payer: University Health Alliance Commercial |
$202.64
|
|
|
PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 31240
|
| Min. Negotiated Rate |
$136.81 |
| Max. Negotiated Rate |
$235.45 |
| Rate for Payer: AlohaCare Medicaid |
$161.67
|
| Rate for Payer: AlohaCare Medicare |
$136.81
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Devoted Health Medicare |
$150.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.68
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.81
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$483.61
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: AlohaCare Medicaid |
$170.20
|
| Rate for Payer: AlohaCare Medicare |
$144.57
|
| Rate for Payer: Cash Price |
$290.17
|
| Rate for Payer: Cash Price |
$290.17
|
| Rate for Payer: Devoted Health Medicare |
$159.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$170.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$282.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$170.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.76
|
| Rate for Payer: Health Management Network Commercial |
$411.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.57
|
| Rate for Payer: University Health Alliance Commercial |
$211.23
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS
|
Professional
|
Both
|
$5,849.55
|
|
|
Service Code
|
HCPCS 31298
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$4,972.12 |
| Rate for Payer: AlohaCare Medicaid |
$256.59
|
| Rate for Payer: AlohaCare Medicare |
$213.69
|
| Rate for Payer: Cash Price |
$3,509.73
|
| Rate for Payer: Cash Price |
$3,509.73
|
| Rate for Payer: Devoted Health Medicare |
$235.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$428.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,367.22
|
| Rate for Payer: Health Management Network Commercial |
$4,972.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.69
|
| Rate for Payer: University Health Alliance Commercial |
$250.09
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$3,153.83
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$151.34 |
| Max. Negotiated Rate |
$2,680.76 |
| Rate for Payer: AlohaCare Medicaid |
$180.64
|
| Rate for Payer: AlohaCare Medicare |
$151.34
|
| Rate for Payer: Cash Price |
$1,892.30
|
| Rate for Payer: Cash Price |
$1,892.30
|
| Rate for Payer: Devoted Health Medicare |
$166.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$317.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,588.30
|
| Rate for Payer: Health Management Network Commercial |
$2,680.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.34
|
| Rate for Payer: University Health Alliance Commercial |
$177.19
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,107.09
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$2,641.03 |
| Rate for Payer: AlohaCare Medicaid |
$159.12
|
| Rate for Payer: AlohaCare Medicare |
$134.12
|
| Rate for Payer: Cash Price |
$1,864.25
|
| Rate for Payer: Cash Price |
$1,864.25
|
| Rate for Payer: Devoted Health Medicare |
$147.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,553.72
|
| Rate for Payer: Health Management Network Commercial |
$2,641.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.12
|
| Rate for Payer: University Health Alliance Commercial |
$155.74
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,084.15
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,621.53 |
| Rate for Payer: AlohaCare Medicaid |
$145.32
|
| Rate for Payer: AlohaCare Medicare |
$122.91
|
| Rate for Payer: Cash Price |
$1,850.49
|
| Rate for Payer: Cash Price |
$1,850.49
|
| Rate for Payer: Devoted Health Medicare |
$135.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$261.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,558.14
|
| Rate for Payer: Health Management Network Commercial |
$2,621.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.91
|
| Rate for Payer: University Health Alliance Commercial |
$190.23
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$369.54 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: AlohaCare Medicaid |
$445.15
|
| Rate for Payer: AlohaCare Medicare |
$369.54
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Devoted Health Medicare |
$406.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$464.36
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.54
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$413.53 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: AlohaCare Medicaid |
$498.84
|
| Rate for Payer: AlohaCare Medicare |
$413.53
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Devoted Health Medicare |
$454.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$413.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$521.30
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$496.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$496.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$413.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$413.53
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$390.96 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: AlohaCare Medicaid |
$470.48
|
| Rate for Payer: AlohaCare Medicare |
$390.96
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$430.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$390.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$492.18
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$469.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$469.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$470.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$470.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.96
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$815.74
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$203.72 |
| Max. Negotiated Rate |
$693.38 |
| Rate for Payer: AlohaCare Medicaid |
$244.18
|
| Rate for Payer: AlohaCare Medicare |
$203.72
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Devoted Health Medicare |
$224.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$408.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$244.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.88
|
| Rate for Payer: Health Management Network Commercial |
$693.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.72
|
| Rate for Payer: University Health Alliance Commercial |
$302.76
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$593.58 |
| Rate for Payer: AlohaCare Medicaid |
$378.19
|
| Rate for Payer: AlohaCare Medicare |
$313.54
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Devoted Health Medicare |
$344.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$548.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$378.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$378.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.54
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$269.70 |
| Max. Negotiated Rate |
$560.82 |
| Rate for Payer: AlohaCare Medicaid |
$323.56
|
| Rate for Payer: AlohaCare Medicare |
$269.70
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Devoted Health Medicare |
$296.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.82
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$323.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.70
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: AlohaCare Medicaid |
$39.16
|
| Rate for Payer: AlohaCare Medicare |
$33.82
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.04
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.82
|
|
