|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: AlohaCare Medicaid |
$305.62
|
| Rate for Payer: AlohaCare Medicare |
$266.80
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$293.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$267.54
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$320.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$320.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$320.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$305.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$305.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.80
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$278.69 |
| Max. Negotiated Rate |
$463.25 |
| Rate for Payer: AlohaCare Medicaid |
$319.45
|
| Rate for Payer: AlohaCare Medicare |
$278.69
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Devoted Health Medicare |
$306.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$327.86
|
| Rate for Payer: Health Management Network Commercial |
$463.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$334.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$334.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$319.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$319.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.69
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$247.26 |
| Max. Negotiated Rate |
$415.65 |
| Rate for Payer: AlohaCare Medicaid |
$285.29
|
| Rate for Payer: AlohaCare Medicare |
$252.26
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Devoted Health Medicare |
$277.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$252.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.26
|
| Rate for Payer: Health Management Network Commercial |
$415.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$302.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.26
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$238.86 |
| Max. Negotiated Rate |
$393.55 |
| Rate for Payer: AlohaCare Medicaid |
$270.67
|
| Rate for Payer: AlohaCare Medicare |
$238.86
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Devoted Health Medicare |
$262.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$238.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$284.44
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$286.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$270.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$238.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$270.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$238.86
|
|
|
PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 58150
|
| Min. Negotiated Rate |
$920.28 |
| Max. Negotiated Rate |
$1,490.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,028.32
|
| Rate for Payer: AlohaCare Medicare |
$920.28
|
| Rate for Payer: Cash Price |
$1,052.40
|
| Rate for Payer: Cash Price |
$1,052.40
|
| Rate for Payer: Devoted Health Medicare |
$1,012.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$920.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network Commercial |
$1,490.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,104.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,104.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,104.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,028.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$920.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,028.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$920.28
|
|
|
PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 60220
|
| Min. Negotiated Rate |
$638.39 |
| Max. Negotiated Rate |
$1,042.95 |
| Rate for Payer: AlohaCare Medicaid |
$717.66
|
| Rate for Payer: AlohaCare Medicare |
$638.39
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Devoted Health Medicare |
$702.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.78
|
| Rate for Payer: Health Management Network Commercial |
$1,042.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$717.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$717.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.39
|
|
|
PR TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 60225
|
| Min. Negotiated Rate |
$726.70 |
| Max. Negotiated Rate |
$1,382.10 |
| Rate for Payer: AlohaCare Medicaid |
$951.93
|
| Rate for Payer: AlohaCare Medicare |
$845.72
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Devoted Health Medicare |
$930.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$845.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$726.70
|
| Rate for Payer: Health Management Network Commercial |
$1,382.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,014.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,014.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,014.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$951.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$845.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$951.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$845.72
|
|
|
PR TRACHEOBRONCHOSCOPY THRU EST TRACHEOSTOMY INC
|
Professional
|
Both
|
$321.77
|
|
|
Service Code
|
HCPCS 31615
|
| Min. Negotiated Rate |
$102.98 |
| Max. Negotiated Rate |
$273.50 |
| Rate for Payer: AlohaCare Medicaid |
$118.32
|
| Rate for Payer: AlohaCare Medicare |
$102.98
|
| Rate for Payer: Cash Price |
$193.06
|
| Rate for Payer: Cash Price |
$193.06
|
| Rate for Payer: Devoted Health Medicare |
$113.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$195.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.82
|
| Rate for Payer: Health Management Network Commercial |
$273.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.98
|
| Rate for Payer: University Health Alliance Commercial |
$153.90
|
|
|
PR TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 31613
|
| Min. Negotiated Rate |
$241.28 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: AlohaCare Medicaid |
$451.13
|
| Rate for Payer: AlohaCare Medicare |
$415.42
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Devoted Health Medicare |
$456.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$415.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.28
|
| Rate for Payer: Health Management Network Commercial |
$646.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$498.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$498.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$415.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$451.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$415.42
|
|
|
PR TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL
|
Professional
|
Both
|
$533.00
|
|
|
Service Code
|
HCPCS 31603
|
| Min. Negotiated Rate |
$269.83 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: AlohaCare Medicaid |
$312.05
|
| Rate for Payer: AlohaCare Medicare |
$269.83
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Devoted Health Medicare |
$296.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.58
|
| Rate for Payer: Health Management Network Commercial |
$453.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$312.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$312.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.83
|
|
|
PR TRACHEOSTOMY PLANNED SEPARATE PROCEDURE
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 31600
|
| Min. Negotiated Rate |
$265.91 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: AlohaCare Medicaid |
$298.19
|
| Rate for Payer: AlohaCare Medicare |
$265.91
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Devoted Health Medicare |
$292.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.46
|
| Rate for Payer: Health Management Network Commercial |
$432.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$298.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$265.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$298.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.91
|
|
|
PR TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 31502
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$55.64 |
| Rate for Payer: AlohaCare Medicaid |
$34.79
|
| Rate for Payer: AlohaCare Medicare |
$30.19
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Devoted Health Medicare |
$33.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.64
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.19
|
|
|
PR TRANSCATHETER BIOPSY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 37200
|
| Min. Negotiated Rate |
$181.13 |
| Max. Negotiated Rate |
$458.00 |
| Rate for Payer: AlohaCare Medicaid |
$206.51
|
| Rate for Payer: AlohaCare Medicare |
$181.13
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$199.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$217.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$217.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$206.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$206.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.13
|
| Rate for Payer: University Health Alliance Commercial |
$458.00
|
|
|
PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I
|
Professional
|
Both
|
$1,054.00
|
|
|
Service Code
|
HCPCS 34712
|
| Min. Negotiated Rate |
$567.45 |
| Max. Negotiated Rate |
$1,019.78 |
| Rate for Payer: AlohaCare Medicaid |
$618.85
|
| Rate for Payer: AlohaCare Medicare |
$567.45
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Devoted Health Medicare |
$624.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$567.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$711.62
|
| Rate for Payer: Health Management Network Commercial |
$895.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$680.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$680.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$680.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$618.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$567.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$618.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$567.45
|
| Rate for Payer: University Health Alliance Commercial |
$1,019.78
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$555.98
|
|
|
Service Code
|
HCPCS 99496
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$472.58 |
| Rate for Payer: AlohaCare Medicare |
$167.31
|
| Rate for Payer: Cash Price |
$333.59
|
| Rate for Payer: Cash Price |
$333.59
|
| Rate for Payer: Devoted Health Medicare |
$184.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$192.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$192.60
|
| Rate for Payer: Health Management Network Commercial |
$472.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.31
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$409.52
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$122.73 |
| Max. Negotiated Rate |
$348.09 |
| Rate for Payer: AlohaCare Medicare |
$122.73
|
| Rate for Payer: Cash Price |
$245.71
|
| Rate for Payer: Cash Price |
$245.71
|
| Rate for Payer: Devoted Health Medicare |
$135.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.80
|
| Rate for Payer: Health Management Network Commercial |
$348.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.73
|
|
|
PR TRANSORAL LOWER ESOPHAGEAL MYOTOMY
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 43497
|
| Min. Negotiated Rate |
$724.03 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: AlohaCare Medicaid |
$795.32
|
| Rate for Payer: AlohaCare Medicare |
$724.03
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Devoted Health Medicare |
$796.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$724.03
|
| Rate for Payer: Health Management Network Commercial |
$1,154.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$868.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$868.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$868.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$795.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$724.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$795.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$724.03
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$187.46 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: AlohaCare Medicaid |
$441.16
|
| Rate for Payer: AlohaCare Medicare |
$420.24
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Devoted Health Medicare |
$462.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$420.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.46
|
| Rate for Payer: Health Management Network Commercial |
$641.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$504.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$504.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$504.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$420.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$441.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$420.24
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 93293 26
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: AlohaCare Medicaid |
$48.56
|
| Rate for Payer: AlohaCare Medicare |
$13.63
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Devoted Health Medicare |
$14.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.60
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.63
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: AlohaCare Medicaid |
$48.56
|
| Rate for Payer: AlohaCare Medicare |
$29.82
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$32.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.60
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.82
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: AlohaCare Medicaid |
$48.56
|
| Rate for Payer: AlohaCare Medicare |
$43.45
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$47.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.60
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.45
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$982.28 |
| Max. Negotiated Rate |
$1,682.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,155.18
|
| Rate for Payer: AlohaCare Medicare |
$1,027.52
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Devoted Health Medicare |
$1,130.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,027.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$982.28
|
| Rate for Payer: Health Management Network Commercial |
$1,682.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,233.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,233.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,233.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,155.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,027.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,155.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,027.52
|
|
|
PR TRANSURETHRAL INCISION PROSTATE
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 52450
|
| Min. Negotiated Rate |
$373.10 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: AlohaCare Medicaid |
$488.99
|
| Rate for Payer: AlohaCare Medicare |
$444.69
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Devoted Health Medicare |
$489.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$444.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.10
|
| Rate for Payer: Health Management Network Commercial |
$713.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$533.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$533.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$533.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$488.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$444.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$488.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$444.69
|
|
|
PR TRANSURETHRAL RESECTION BLADDER NECK
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 52500
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: AlohaCare Medicaid |
$506.68
|
| Rate for Payer: AlohaCare Medicare |
$359.72
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Devoted Health Medicare |
$395.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.06
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.72
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 24605
|
| Min. Negotiated Rate |
$236.34 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: AlohaCare Medicaid |
$513.09
|
| Rate for Payer: AlohaCare Medicare |
$497.43
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Devoted Health Medicare |
$547.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$497.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.34
|
| Rate for Payer: Health Management Network Commercial |
$745.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$596.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$596.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$596.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$513.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$497.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$513.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$497.43
|
|
