|
PR URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 53415
|
| Min. Negotiated Rate |
$869.44 |
| Max. Negotiated Rate |
$1,649.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,132.92
|
| Rate for Payer: AlohaCare Medicare |
$1,008.95
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Devoted Health Medicare |
$1,109.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,008.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$869.44
|
| Rate for Payer: Health Management Network Commercial |
$1,649.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,210.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,210.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,210.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,132.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,008.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,132.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,008.95
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$68.93
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: AlohaCare Medicaid |
$38.44
|
| Rate for Payer: AlohaCare Medicare |
$39.39
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Devoted Health Medicare |
$43.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.39
|
| Rate for Payer: Health Management Network Commercial |
$58.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.39
|
|
|
PR UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$585.99
|
|
|
Service Code
|
HCPCS 42140
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$498.09 |
| Rate for Payer: AlohaCare Medicaid |
$176.20
|
| Rate for Payer: AlohaCare Medicare |
$160.91
|
| Rate for Payer: Cash Price |
$351.59
|
| Rate for Payer: Cash Price |
$351.59
|
| Rate for Payer: Devoted Health Medicare |
$177.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.10
|
| Rate for Payer: Health Management Network Commercial |
$498.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.91
|
| Rate for Payer: University Health Alliance Commercial |
$223.74
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$709.02 |
| Max. Negotiated Rate |
$1,249.50 |
| Rate for Payer: AlohaCare Medicaid |
$864.61
|
| Rate for Payer: AlohaCare Medicare |
$766.52
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Devoted Health Medicare |
$843.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$766.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.02
|
| Rate for Payer: Health Management Network Commercial |
$1,249.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$919.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$919.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$919.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$864.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$766.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$864.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$766.52
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$553.28 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: AlohaCare Medicaid |
$770.52
|
| Rate for Payer: AlohaCare Medicare |
$680.00
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Devoted Health Medicare |
$748.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$680.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$553.28
|
| Rate for Payer: Health Management Network Commercial |
$1,114.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$816.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$816.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$770.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$680.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$770.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$680.00
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,517.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,049.57
|
| Rate for Payer: AlohaCare Medicare |
$924.69
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Devoted Health Medicare |
$1,017.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$924.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,517.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,109.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,109.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,049.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$924.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,049.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$924.69
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.65
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$13,169.38
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$398.82 |
| Max. Negotiated Rate |
$11,193.97 |
| Rate for Payer: AlohaCare Medicaid |
$450.59
|
| Rate for Payer: AlohaCare Medicare |
$398.82
|
| Rate for Payer: Cash Price |
$7,901.63
|
| Rate for Payer: Cash Price |
$7,901.63
|
| Rate for Payer: Devoted Health Medicare |
$438.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$450.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$954.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$398.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,070.62
|
| Rate for Payer: Health Management Network Commercial |
$11,193.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$478.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$478.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$450.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$398.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$450.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$398.82
|
| Rate for Payer: University Health Alliance Commercial |
$635.00
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$12,004.12
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$553.83 |
| Max. Negotiated Rate |
$10,203.50 |
| Rate for Payer: AlohaCare Medicaid |
$635.64
|
| Rate for Payer: AlohaCare Medicare |
$553.83
|
| Rate for Payer: Cash Price |
$7,202.47
|
| Rate for Payer: Cash Price |
$7,202.47
|
| Rate for Payer: Devoted Health Medicare |
$609.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$635.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,327.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$553.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$635.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,881.64
|
| Rate for Payer: Health Management Network Commercial |
$10,203.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$664.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$664.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$635.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$553.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$635.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$553.83
|
| Rate for Payer: University Health Alliance Commercial |
$893.00
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$8,638.33
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$359.22 |
| Max. Negotiated Rate |
$7,342.58 |
| Rate for Payer: AlohaCare Medicaid |
$406.77
|
| Rate for Payer: AlohaCare Medicare |
$359.22
|
| Rate for Payer: Cash Price |
$5,183.00
|
| Rate for Payer: Cash Price |
$5,183.00
|
| Rate for Payer: Devoted Health Medicare |
$395.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$406.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$855.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$406.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,297.24
|
| Rate for Payer: Health Management Network Commercial |
$7,342.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$406.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.22
|
| Rate for Payer: University Health Alliance Commercial |
$580.00
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$15,787.59
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$471.76 |
| Max. Negotiated Rate |
$13,419.45 |
| Rate for Payer: AlohaCare Medicaid |
$539.60
|
| Rate for Payer: AlohaCare Medicare |
$471.76
|
| Rate for Payer: Cash Price |
$9,472.55
|
| Rate for Payer: Cash Price |
$9,472.55
|
| Rate for Payer: Devoted Health Medicare |
$518.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$539.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,137.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$471.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$539.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,318.06
|
| Rate for Payer: Health Management Network Commercial |
$13,419.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$566.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$539.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$471.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$539.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$471.76
|
| Rate for Payer: University Health Alliance Commercial |
$750.00
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$650.48
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$552.91 |
| Rate for Payer: AlohaCare Medicaid |
$240.51
|
| Rate for Payer: AlohaCare Medicare |
$225.11
|
| Rate for Payer: Cash Price |
$390.29
|
| Rate for Payer: Cash Price |
$390.29
|
| Rate for Payer: Devoted Health Medicare |
$247.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$240.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$391.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$240.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$552.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$270.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$270.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.11
|
| Rate for Payer: University Health Alliance Commercial |
$510.87
|
|
|
PR VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 95713
|
| Min. Negotiated Rate |
$589.38 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$589.38
|
| Rate for Payer: Health Management Network Commercial |
$1,090.55
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR
|
Professional
|
Both
|
$2,630.00
|
|
|
Service Code
|
HCPCS 95716
|
| Min. Negotiated Rate |
$1,252.22 |
| Max. Negotiated Rate |
$2,235.50 |
| Rate for Payer: Cash Price |
$1,578.00
|
| Rate for Payer: Cash Price |
$1,578.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,252.22
|
| Rate for Payer: Health Management Network Commercial |
$2,235.50
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR
|
Professional
|
Both
|
$1,910.00
|
|
|
Service Code
|
HCPCS 95715
|
| Min. Negotiated Rate |
$909.33 |
| Max. Negotiated Rate |
$1,623.50 |
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$909.33
|
| Rate for Payer: Health Management Network Commercial |
$1,623.50
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR UNMONITORED
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 95714
|
| Min. Negotiated Rate |
$324.79 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$324.79
|
| Rate for Payer: Health Management Network Commercial |
$579.70
|
|
|
PR VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 36425
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: AlohaCare Medicaid |
$38.83
|
| Rate for Payer: AlohaCare Medicare |
$32.53
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$35.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.08
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.53
|
|
|
PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$249.60
|
|
|
Service Code
|
HCPCS 69424
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: AlohaCare Medicaid |
$63.44
|
| Rate for Payer: AlohaCare Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Devoted Health Medicare |
$63.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$63.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$103.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$212.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.57
|
| Rate for Payer: University Health Alliance Commercial |
$81.89
|
|
|
PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT
|
Professional
|
Both
|
$996.56
|
|
|
Service Code
|
HCPCS 40500
|
| Min. Negotiated Rate |
$278.46 |
| Max. Negotiated Rate |
$847.08 |
| Rate for Payer: AlohaCare Medicaid |
$395.80
|
| Rate for Payer: AlohaCare Medicare |
$348.05
|
| Rate for Payer: Cash Price |
$597.94
|
| Rate for Payer: Cash Price |
$597.94
|
| Rate for Payer: Devoted Health Medicare |
$382.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$395.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$644.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$348.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$395.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.46
|
| Rate for Payer: Health Management Network Commercial |
$847.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$417.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$417.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$417.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$348.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$348.05
|
| Rate for Payer: University Health Alliance Commercial |
$507.58
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$2,282.25 |
| Max. Negotiated Rate |
$2,282.25 |
| Rate for Payer: Cash Price |
$1,611.00
|
| Rate for Payer: Health Management Network Commercial |
$2,282.25
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$52.01
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$44.21 |
| Rate for Payer: AlohaCare Medicaid |
$25.52
|
| Rate for Payer: AlohaCare Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: Devoted Health Medicare |
$24.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.77
|
| Rate for Payer: Health Management Network Commercial |
$44.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.51
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$79.96
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: AlohaCare Medicaid |
$37.83
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.95
|
| Rate for Payer: Health Management Network Commercial |
$67.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$50.89
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$43.26 |
| Rate for Payer: AlohaCare Medicaid |
$18.56
|
| Rate for Payer: AlohaCare Medicare |
$15.78
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Devoted Health Medicare |
$17.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network Commercial |
$43.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.78
|
| Rate for Payer: University Health Alliance Commercial |
$25.08
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$35.79
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AlohaCare Medicaid |
$9.04
|
| Rate for Payer: AlohaCare Medicare |
$7.92
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Cash Price |
$21.47
|
| Rate for Payer: Devoted Health Medicare |
$8.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.38
|
| Rate for Payer: Health Management Network Commercial |
$30.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.92
|
| Rate for Payer: University Health Alliance Commercial |
$50.00
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: AlohaCare Medicaid |
$211.33
|
| Rate for Payer: AlohaCare Medicare |
$171.34
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$188.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$205.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.34
|
|
