|
PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$2,083.30
|
|
|
Service Code
|
HCPCS 50433
|
| Min. Negotiated Rate |
$217.12 |
| Max. Negotiated Rate |
$1,770.81 |
| Rate for Payer: AlohaCare Medicaid |
$247.81
|
| Rate for Payer: AlohaCare Medicare |
$217.12
|
| Rate for Payer: Cash Price |
$1,249.98
|
| Rate for Payer: Cash Price |
$1,249.98
|
| Rate for Payer: Devoted Health Medicare |
$238.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$247.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$431.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$217.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$247.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,306.24
|
| Rate for Payer: Health Management Network Commercial |
$1,770.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$217.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$217.12
|
|
|
PR PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT
|
Professional
|
Both
|
$938.18
|
|
|
Service Code
|
HCPCS 32553
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$797.45 |
| Rate for Payer: AlohaCare Medicaid |
$171.56
|
| Rate for Payer: AlohaCare Medicare |
$149.88
|
| Rate for Payer: Cash Price |
$562.91
|
| Rate for Payer: Cash Price |
$562.91
|
| Rate for Payer: Devoted Health Medicare |
$164.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$308.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.56
|
| Rate for Payer: Health Management Network Commercial |
$797.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.88
|
| Rate for Payer: University Health Alliance Commercial |
$230.16
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$915.45 |
| Max. Negotiated Rate |
$1,503.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,042.65
|
| Rate for Payer: AlohaCare Medicare |
$915.45
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Devoted Health Medicare |
$1,007.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$915.45
|
| Rate for Payer: Health Management Network Commercial |
$1,503.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,098.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,098.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,042.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$915.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,042.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$915.45
|
|
|
PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
HCPCS 50695
|
| Min. Negotiated Rate |
$289.87 |
| Max. Negotiated Rate |
$1,552.95 |
| Rate for Payer: AlohaCare Medicaid |
$332.56
|
| Rate for Payer: AlohaCare Medicare |
$289.87
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Devoted Health Medicare |
$318.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$332.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$565.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$332.56
|
| Rate for Payer: Health Management Network Commercial |
$1,552.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$347.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.87
|
| Rate for Payer: University Health Alliance Commercial |
$444.23
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$1,839.51
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$1,563.58 |
| Rate for Payer: AlohaCare Medicaid |
$199.34
|
| Rate for Payer: AlohaCare Medicare |
$175.03
|
| Rate for Payer: Cash Price |
$1,103.71
|
| Rate for Payer: Cash Price |
$1,103.71
|
| Rate for Payer: Devoted Health Medicare |
$192.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$346.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,132.56
|
| Rate for Payer: Health Management Network Commercial |
$1,563.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.03
|
|
|
PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
|
Professional
|
Both
|
$2,053.14
|
|
|
Service Code
|
HCPCS 50694
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$1,745.17 |
| Rate for Payer: AlohaCare Medicaid |
$259.82
|
| Rate for Payer: AlohaCare Medicare |
$226.84
|
| Rate for Payer: Cash Price |
$1,231.88
|
| Rate for Payer: Cash Price |
$1,231.88
|
| Rate for Payer: Devoted Health Medicare |
$249.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$259.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$447.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$259.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,236.56
|
| Rate for Payer: Health Management Network Commercial |
$1,745.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$259.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.84
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: AlohaCare Medicaid |
$180.68
|
| Rate for Payer: AlohaCare Medicare |
$166.14
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Devoted Health Medicare |
$182.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.14
|
| Rate for Payer: Health Management Network Commercial |
$262.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$199.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$199.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.14
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$999.96 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,538.31
|
| Rate for Payer: AlohaCare Medicare |
$1,418.72
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Devoted Health Medicare |
$1,560.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,418.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$999.96
|
| Rate for Payer: Health Management Network Commercial |
$2,238.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,702.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,702.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,702.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,538.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,418.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,538.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,418.72
|
|
|
PR PNEUMA/VAC WALK BOOT PRE OTS
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS L4361
|
| Min. Negotiated Rate |
$307.64 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: AlohaCare Medicaid |
$307.64
|
| Rate for Payer: AlohaCare Medicare |
$400.91
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Devoted Health Medicare |
$441.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$307.64
|
| Rate for Payer: Health Management Network Commercial |
$584.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$307.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.91
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$234.22
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$199.09 |
| Rate for Payer: AlohaCare Medicaid |
$86.15
|
| Rate for Payer: AlohaCare Medicare |
$78.01
|
| Rate for Payer: Cash Price |
$140.53
|
| Rate for Payer: Cash Price |
$140.53
|
| Rate for Payer: Devoted Health Medicare |
$85.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$141.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$199.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.01
|
| Rate for Payer: University Health Alliance Commercial |
$107.04
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.41
|
| Rate for Payer: Health Management Network Commercial |
$149.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$464.62 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: AlohaCare Medicaid |
$629.12
|
| Rate for Payer: AlohaCare Medicare |
$544.43
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Devoted Health Medicare |
$598.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$544.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$464.62
|
| Rate for Payer: Health Management Network Commercial |
$908.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$653.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$653.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$653.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$629.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$544.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$629.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$544.43
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$464.24
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$394.60 |
| Rate for Payer: AlohaCare Medicaid |
$172.57
|
| Rate for Payer: AlohaCare Medicare |
$151.93
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Devoted Health Medicare |
$167.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.04
|
| Rate for Payer: Health Management Network Commercial |
$394.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.93
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$226.26
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: AlohaCare Medicaid |
$29.88
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$135.76
|
| Rate for Payer: Cash Price |
$135.76
|
| Rate for Payer: Devoted Health Medicare |
$28.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$50.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.88
|
| Rate for Payer: Health Management Network Commercial |
$192.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$36.64
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$5.83
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$6.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.83
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$320.55
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$272.47 |
| Rate for Payer: AlohaCare Medicaid |
$173.87
|
| Rate for Payer: AlohaCare Medicare |
$183.17
|
| Rate for Payer: Cash Price |
$192.33
|
| Rate for Payer: Cash Price |
$192.33
|
| Rate for Payer: Devoted Health Medicare |
$201.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$181.50
|
| Rate for Payer: Health Management Network Commercial |
$272.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.17
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$254.87
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$216.64 |
| Rate for Payer: AlohaCare Medicaid |
$137.48
|
| Rate for Payer: AlohaCare Medicare |
$145.26
|
| Rate for Payer: Cash Price |
$152.92
|
| Rate for Payer: Cash Price |
$152.92
|
| Rate for Payer: Devoted Health Medicare |
$159.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.58
|
| Rate for Payer: Health Management Network Commercial |
$216.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.26
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$133.47
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$146.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.45
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.47
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$834.60 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.57
|
| Rate for Payer: AlohaCare Medicare |
$1,001.17
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Devoted Health Medicare |
$1,101.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,001.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$834.60
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,201.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,201.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,201.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,001.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,001.17
|
|
|
PR PREPARATION MOULAGE CUSTOM BREAST IMPLANT
|
Professional
|
Both
|
$550.50
|
|
|
Service Code
|
HCPCS 19396
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$467.93 |
| Rate for Payer: AlohaCare Medicaid |
$144.72
|
| Rate for Payer: AlohaCare Medicare |
$126.58
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Devoted Health Medicare |
$139.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$241.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.52
|
| Rate for Payer: Health Management Network Commercial |
$467.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.58
|
| Rate for Payer: University Health Alliance Commercial |
$166.12
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$388.66 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: AlohaCare Medicaid |
$435.14
|
| Rate for Payer: AlohaCare Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Devoted Health Medicare |
$427.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$388.66
|
| Rate for Payer: Health Management Network Commercial |
$633.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$466.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$466.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$388.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$388.66
|
|
|
PR PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN
|
Professional
|
Both
|
$34.42
|
|
|
Service Code
|
HCPCS 95165
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$29.26 |
| Rate for Payer: AlohaCare Medicaid |
$3.33
|
| Rate for Payer: AlohaCare Medicare |
$2.58
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Devoted Health Medicare |
$2.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.70
|
| Rate for Payer: Health Management Network Commercial |
$29.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.58
|
| Rate for Payer: University Health Alliance Commercial |
$3.76
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$748.81
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$228.13 |
| Max. Negotiated Rate |
$636.49 |
| Rate for Payer: AlohaCare Medicaid |
$260.04
|
| Rate for Payer: AlohaCare Medicare |
$228.13
|
| Rate for Payer: Cash Price |
$449.29
|
| Rate for Payer: Cash Price |
$449.29
|
| Rate for Payer: Devoted Health Medicare |
$250.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$260.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$438.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$260.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.76
|
| Rate for Payer: Health Management Network Commercial |
$636.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.13
|
| Rate for Payer: University Health Alliance Commercial |
$301.68
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$224.32
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$190.67 |
| Rate for Payer: AlohaCare Medicaid |
$87.34
|
| Rate for Payer: AlohaCare Medicare |
$75.39
|
| Rate for Payer: Cash Price |
$134.59
|
| Rate for Payer: Cash Price |
$134.59
|
| Rate for Payer: Devoted Health Medicare |
$82.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$150.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.34
|
| Rate for Payer: Health Management Network Commercial |
$190.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.39
|
| Rate for Payer: University Health Alliance Commercial |
$103.56
|
|
|
PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$672.70
|
|
|
Service Code
|
HCPCS 15002
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$571.79 |
| Rate for Payer: AlohaCare Medicaid |
$218.73
|
| Rate for Payer: AlohaCare Medicare |
$195.66
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Devoted Health Medicare |
$215.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$218.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$367.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$218.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$295.88
|
| Rate for Payer: Health Management Network Commercial |
$571.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$234.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.66
|
| Rate for Payer: University Health Alliance Commercial |
$252.86
|
|
