|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$2,172.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,509.20
|
| Rate for Payer: AlohaCare Medicare |
$1,430.35
|
| Rate for Payer: Cash Price |
$1,533.60
|
| Rate for Payer: Cash Price |
$1,533.60
|
| Rate for Payer: Devoted Health Medicare |
$1,573.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,430.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.00
|
| Rate for Payer: Health Management Network Commercial |
$2,172.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,716.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,716.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,716.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,509.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,430.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,509.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,430.35
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$2,237.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$1,901.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,323.48
|
| Rate for Payer: AlohaCare Medicare |
$1,274.96
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Devoted Health Medicare |
$1,402.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,274.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.98
|
| Rate for Payer: Health Management Network Commercial |
$1,901.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,529.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,529.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,529.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,323.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,274.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,323.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,274.96
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$12.42
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: AlohaCare Medicaid |
$6.71
|
| Rate for Payer: AlohaCare Medicare |
$7.10
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Devoted Health Medicare |
$7.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network Commercial |
$10.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.10
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: AlohaCare Medicaid |
$7.07
|
| Rate for Payer: AlohaCare Medicare |
$8.93
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$9.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.11
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.93
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$28.05
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: AlohaCare Medicaid |
$13.78
|
| Rate for Payer: AlohaCare Medicare |
$16.03
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Devoted Health Medicare |
$17.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.05
|
| Rate for Payer: Health Management Network Commercial |
$23.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.03
|
|
|
PR RHYTIDECTOMY FOREHEAD
|
Professional
|
Both
|
$1,178.00
|
|
|
Service Code
|
HCPCS 15824
|
| Min. Negotiated Rate |
$556.14 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.14
|
| Rate for Payer: Health Management Network Commercial |
$1,001.30
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$1,178.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$446.94 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$446.94
|
| Rate for Payer: Health Management Network Commercial |
$1,001.30
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 93451 26
|
| Min. Negotiated Rate |
$127.15 |
| Max. Negotiated Rate |
$954.05 |
| Rate for Payer: AlohaCare Medicaid |
$954.05
|
| Rate for Payer: AlohaCare Medicare |
$127.15
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$139.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.15
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$954.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$954.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.15
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 93451 TC
|
| Min. Negotiated Rate |
$822.02 |
| Max. Negotiated Rate |
$2,190.45 |
| Rate for Payer: AlohaCare Medicaid |
$954.05
|
| Rate for Payer: AlohaCare Medicare |
$822.02
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Devoted Health Medicare |
$904.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$822.02
|
| Rate for Payer: Health Management Network Commercial |
$2,190.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$986.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$954.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$822.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$954.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$822.02
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$949.17 |
| Max. Negotiated Rate |
$2,380.00 |
| Rate for Payer: AlohaCare Medicaid |
$954.05
|
| Rate for Payer: AlohaCare Medicare |
$949.17
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Devoted Health Medicare |
$1,044.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.17
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$954.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$954.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.17
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$627.64 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: AlohaCare Medicaid |
$803.84
|
| Rate for Payer: AlohaCare Medicare |
$726.44
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Devoted Health Medicare |
$799.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$627.64
|
| Rate for Payer: Health Management Network Commercial |
$1,173.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$871.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$871.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$803.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.44
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$3,379.00
|
|
|
Service Code
|
HCPCS 93461 TC
|
| Min. Negotiated Rate |
$1,052.93 |
| Max. Negotiated Rate |
$2,872.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,479.55
|
| Rate for Payer: AlohaCare Medicare |
$1,052.93
|
| Rate for Payer: Cash Price |
$2,027.40
|
| Rate for Payer: Cash Price |
$2,027.40
|
| Rate for Payer: Devoted Health Medicare |
$1,158.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,052.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,625.38
|
| Rate for Payer: Health Management Network Commercial |
$2,872.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,263.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,263.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,263.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,479.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,052.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,479.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,052.93
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$4,069.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$1,447.02 |
| Max. Negotiated Rate |
$3,458.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,479.55
|
| Rate for Payer: AlohaCare Medicare |
$1,447.02
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Devoted Health Medicare |
$1,591.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,447.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,625.38
|
| Rate for Payer: Health Management Network Commercial |
$3,458.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,736.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,736.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,736.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,479.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,447.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,479.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,447.02
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 93461 26
|
| Min. Negotiated Rate |
$394.09 |
| Max. Negotiated Rate |
$1,625.38 |
| Rate for Payer: AlohaCare Medicaid |
$1,479.55
|
| Rate for Payer: AlohaCare Medicare |
$394.09
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Devoted Health Medicare |
$433.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$394.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,625.38
|
| Rate for Payer: Health Management Network Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,479.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$394.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,479.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$394.09
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 93460 26
|
| Min. Negotiated Rate |
$356.93 |
| Max. Negotiated Rate |
$1,341.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,341.44
|
| Rate for Payer: AlohaCare Medicare |
$356.93
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Devoted Health Medicare |
$392.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.93
|
| Rate for Payer: Health Management Network Commercial |
$531.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,341.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,341.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.93
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$3,689.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$1,313.21 |
| Max. Negotiated Rate |
$3,135.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,341.44
|
| Rate for Payer: AlohaCare Medicare |
$1,313.21
|
| Rate for Payer: Cash Price |
$2,213.40
|
| Rate for Payer: Cash Price |
$2,213.40
|
| Rate for Payer: Devoted Health Medicare |
$1,444.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,313.21
|
| Rate for Payer: Health Management Network Commercial |
$3,135.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,575.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,575.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,575.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,341.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,313.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,341.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,313.21
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$3,064.00
|
|
|
Service Code
|
HCPCS 93460 TC
|
| Min. Negotiated Rate |
$956.28 |
| Max. Negotiated Rate |
$2,604.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,341.44
|
| Rate for Payer: AlohaCare Medicare |
$956.28
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Devoted Health Medicare |
$1,051.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$956.28
|
| Rate for Payer: Health Management Network Commercial |
$2,604.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,147.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,147.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,147.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,341.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$956.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,341.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$956.28
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$3,456.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$1,219.14 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,241.29
|
| Rate for Payer: AlohaCare Medicare |
$1,219.14
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Devoted Health Medicare |
$1,341.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,219.14
|
| Rate for Payer: Health Management Network Commercial |
$2,937.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,462.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,462.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,462.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,241.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,219.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,241.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,219.14
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
HCPCS 93453 TC
|
| Min. Negotiated Rate |
$916.59 |
| Max. Negotiated Rate |
$2,487.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,241.29
|
| Rate for Payer: AlohaCare Medicare |
$916.59
|
| Rate for Payer: Cash Price |
$1,756.20
|
| Rate for Payer: Cash Price |
$1,756.20
|
| Rate for Payer: Devoted Health Medicare |
$1,008.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$916.59
|
| Rate for Payer: Health Management Network Commercial |
$2,487.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,099.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,099.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,099.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,241.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$916.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,241.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$916.59
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 93453 26
|
| Min. Negotiated Rate |
$302.55 |
| Max. Negotiated Rate |
$1,241.29 |
| Rate for Payer: AlohaCare Medicaid |
$1,241.29
|
| Rate for Payer: AlohaCare Medicare |
$302.55
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$332.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$302.55
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$363.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$363.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,241.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,241.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.55
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$532.48 |
| Max. Negotiated Rate |
$1,222.30 |
| Rate for Payer: AlohaCare Medicaid |
$843.01
|
| Rate for Payer: AlohaCare Medicare |
$750.98
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Devoted Health Medicare |
$826.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$532.48
|
| Rate for Payer: Health Management Network Commercial |
$1,222.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$901.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$901.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$843.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$843.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.98
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.31
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.46
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$100.82
|
| Rate for Payer: AlohaCare Medicare |
$90.93
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Devoted Health Medicare |
$100.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.64
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.93
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$153.23
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$130.25 |
| Rate for Payer: AlohaCare Medicaid |
$48.34
|
| Rate for Payer: AlohaCare Medicare |
$41.99
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Devoted Health Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.74
|
| Rate for Payer: Health Management Network Commercial |
$130.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.99
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$119.14
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$101.27 |
| Rate for Payer: AlohaCare Medicaid |
$41.76
|
| Rate for Payer: AlohaCare Medicare |
$38.08
|
| Rate for Payer: Cash Price |
$71.48
|
| Rate for Payer: Cash Price |
$71.48
|
| Rate for Payer: Devoted Health Medicare |
$41.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$68.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$101.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.08
|
| Rate for Payer: University Health Alliance Commercial |
$54.28
|
|
