|
PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ
|
Professional
|
Both
|
$868.94
|
|
|
Service Code
|
HCPCS 37185
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$738.60 |
| Rate for Payer: AlohaCare Medicaid |
$152.69
|
| Rate for Payer: AlohaCare Medicare |
$135.00
|
| Rate for Payer: Cash Price |
$521.36
|
| Rate for Payer: Cash Price |
$521.36
|
| Rate for Payer: Devoted Health Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$152.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$260.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$152.69
|
| Rate for Payer: Health Management Network Commercial |
$738.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$152.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$152.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.00
|
| Rate for Payer: University Health Alliance Commercial |
$243.00
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$285.25
|
|
|
Service Code
|
HCPCS 45300
|
| Min. Negotiated Rate |
$45.28 |
| Max. Negotiated Rate |
$242.46 |
| Rate for Payer: AlohaCare Medicaid |
$48.56
|
| Rate for Payer: AlohaCare Medicare |
$45.28
|
| Rate for Payer: Cash Price |
$171.15
|
| Rate for Payer: Cash Price |
$171.15
|
| Rate for Payer: Devoted Health Medicare |
$49.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$242.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.28
|
| Rate for Payer: University Health Alliance Commercial |
$68.00
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$379.28
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$322.39 |
| Rate for Payer: AlohaCare Medicaid |
$73.76
|
| Rate for Payer: AlohaCare Medicare |
$69.76
|
| Rate for Payer: Cash Price |
$227.57
|
| Rate for Payer: Cash Price |
$227.57
|
| Rate for Payer: Devoted Health Medicare |
$76.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$120.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$322.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.76
|
| Rate for Payer: University Health Alliance Commercial |
$96.67
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$444.34
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$377.69 |
| Rate for Payer: AlohaCare Medicaid |
$99.36
|
| Rate for Payer: AlohaCare Medicare |
$94.03
|
| Rate for Payer: Cash Price |
$266.60
|
| Rate for Payer: Cash Price |
$266.60
|
| Rate for Payer: Devoted Health Medicare |
$103.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$99.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$99.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$377.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.03
|
| Rate for Payer: University Health Alliance Commercial |
$132.12
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$20.28
|
|
|
Service Code
|
HCPCS 95115
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: AlohaCare Medicaid |
$11.66
|
| Rate for Payer: AlohaCare Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Devoted Health Medicare |
$12.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.36
|
| Rate for Payer: Health Management Network Commercial |
$17.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.59
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS
|
Professional
|
Both
|
$24.27
|
|
|
Service Code
|
HCPCS 95117
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: AlohaCare Medicaid |
$13.96
|
| Rate for Payer: AlohaCare Medicare |
$13.87
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Devoted Health Medicare |
$15.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$20.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.87
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 93280 26
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$85.47 |
| Rate for Payer: AlohaCare Medicaid |
$85.47
|
| Rate for Payer: AlohaCare Medicare |
$37.78
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.91
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.78
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 93280 TC
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: AlohaCare Medicaid |
$85.47
|
| Rate for Payer: AlohaCare Medicare |
$47.28
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$52.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.91
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.28
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 93280
|
| Min. Negotiated Rate |
$64.91 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: AlohaCare Medicaid |
$85.47
|
| Rate for Payer: AlohaCare Medicare |
$85.07
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Devoted Health Medicare |
$93.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.91
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.07
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: AlohaCare Medicaid |
$90.62
|
| Rate for Payer: AlohaCare Medicare |
$89.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Devoted Health Medicare |
$98.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.19
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.64
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 93281 26
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: AlohaCare Medicaid |
$90.62
|
| Rate for Payer: AlohaCare Medicare |
$41.97
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$46.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.19
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.97
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 93281 TC
|
| Min. Negotiated Rate |
$47.66 |
| Max. Negotiated Rate |
$131.75 |
| Rate for Payer: AlohaCare Medicaid |
$90.62
|
| Rate for Payer: AlohaCare Medicare |
$47.66
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Devoted Health Medicare |
$52.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.19
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.66
|
|
|
PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR
|
Professional
|
Both
|
$45.54
|
|
|
Service Code
|
HCPCS 99415
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$38.71 |
| Rate for Payer: AlohaCare Medicaid |
$23.32
|
| Rate for Payer: AlohaCare Medicare |
$26.02
|
| Rate for Payer: Cash Price |
$27.32
|
| Rate for Payer: Cash Price |
$27.32
|
| Rate for Payer: Devoted Health Medicare |
$28.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.02
|
| Rate for Payer: Health Management Network Commercial |
$38.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.02
|
|
|
PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL
|
Professional
|
Both
|
$24.92
|
|
|
Service Code
|
HCPCS 99416
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$21.18 |
| Rate for Payer: AlohaCare Medicaid |
$10.90
|
| Rate for Payer: AlohaCare Medicare |
$14.24
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Devoted Health Medicare |
$15.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.24
|
| Rate for Payer: Health Management Network Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.24
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.64
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
|
|
PR PROLONG HOME EVAL ADD 15M
|
Professional
|
Both
|
$61.27
|
|
|
Service Code
|
HCPCS G0318
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$262.46 |
| Rate for Payer: AlohaCare Medicaid |
$30.04
|
| Rate for Payer: AlohaCare Medicare |
$27.42
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Devoted Health Medicare |
$30.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$262.46
|
| Rate for Payer: Health Management Network Commercial |
$52.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.42
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$62.60
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$289.59 |
| Rate for Payer: AlohaCare Medicaid |
$30.61
|
| Rate for Payer: AlohaCare Medicare |
$27.80
|
| Rate for Payer: Cash Price |
$37.56
|
| Rate for Payer: Cash Price |
$37.56
|
| Rate for Payer: Devoted Health Medicare |
$30.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.59
|
| Rate for Payer: Health Management Network Commercial |
$53.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.80
|
| Rate for Payer: University Health Alliance Commercial |
$30.12
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$61.27
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$52.08 |
| Rate for Payer: AlohaCare Medicaid |
$31.57
|
| Rate for Payer: AlohaCare Medicare |
$27.42
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Cash Price |
$36.76
|
| Rate for Payer: Devoted Health Medicare |
$30.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.51
|
| Rate for Payer: Health Management Network Commercial |
$52.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.42
|
| Rate for Payer: University Health Alliance Commercial |
$30.49
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$983.32 |
| Max. Negotiated Rate |
$1,686.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,155.65
|
| Rate for Payer: AlohaCare Medicare |
$1,039.92
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Devoted Health Medicare |
$1,143.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,039.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$983.32
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,247.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,247.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,155.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,039.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,155.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,039.92
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$860.86 |
| Max. Negotiated Rate |
$1,496.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,025.05
|
| Rate for Payer: AlohaCare Medicare |
$927.62
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Devoted Health Medicare |
$1,020.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$927.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$860.86
|
| Rate for Payer: Health Management Network Commercial |
$1,496.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,113.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,113.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,113.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,025.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$927.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,025.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$927.62
|
|
|
PR PROSTATE BIOPSY, ANY MTHD
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
HCPCS G0416
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$873.80 |
| Rate for Payer: AlohaCare Medicaid |
$237.90
|
| Rate for Payer: AlohaCare Medicare |
$387.48
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Devoted Health Medicare |
$426.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$387.48
|
| Rate for Payer: Health Management Network Commercial |
$873.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$464.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$464.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$387.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$387.48
|
|
|
PR PROSTATE BIOPSY, ANY MTHD
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS G0416 TC
|
| Min. Negotiated Rate |
$214.40 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: AlohaCare Medicaid |
$237.90
|
| Rate for Payer: AlohaCare Medicare |
$214.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Devoted Health Medicare |
$235.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.40
|
| Rate for Payer: Health Management Network Commercial |
$615.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.40
|
|
|
PR PROSTATE BIOPSY, ANY MTHD
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS G0416 26
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: AlohaCare Medicaid |
$237.90
|
| Rate for Payer: AlohaCare Medicare |
$173.08
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Devoted Health Medicare |
$190.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.08
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.08
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$480.83
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$133.87 |
| Max. Negotiated Rate |
$408.71 |
| Rate for Payer: AlohaCare Medicaid |
$153.27
|
| Rate for Payer: AlohaCare Medicare |
$133.87
|
| Rate for Payer: Cash Price |
$288.50
|
| Rate for Payer: Cash Price |
$288.50
|
| Rate for Payer: Devoted Health Medicare |
$147.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.27
|
| Rate for Payer: Health Management Network Commercial |
$408.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.87
|
| Rate for Payer: University Health Alliance Commercial |
$203.38
|
|
