|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$68.50 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: AlohaCare Medicaid |
$82.48
|
| Rate for Payer: AlohaCare Medicare |
$73.69
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$81.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.50
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.69
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$161.59 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: AlohaCare Medicaid |
$896.57
|
| Rate for Payer: AlohaCare Medicare |
$779.52
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Devoted Health Medicare |
$857.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.59
|
| Rate for Payer: Health Management Network Commercial |
$1,289.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$935.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$935.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$896.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$896.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.52
|
|
|
PR 2D TTE W OR W/O FOL W/CON,FU
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS C8924
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
|
|
PR 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL
|
Professional
|
Both
|
$105.75
|
|
|
Service Code
|
HCPCS 93319
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: AlohaCare Medicaid |
$23.13
|
| Rate for Payer: AlohaCare Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Devoted Health Medicare |
$22.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.13
|
| Rate for Payer: Health Management Network Commercial |
$89.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.56
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$257.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.49
|
| Rate for Payer: Health Management Network Commercial |
$257.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.35
|
| Rate for Payer: Health Management Network Commercial |
$391.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$543.78
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$462.21 |
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Devoted Health Medicare |
$102.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.50
|
| Rate for Payer: Health Management Network Commercial |
$462.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.74
|
| Rate for Payer: University Health Alliance Commercial |
$140.13
|
|
|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$472.27
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$401.43 |
| Rate for Payer: AlohaCare Medicaid |
$73.51
|
| Rate for Payer: AlohaCare Medicare |
$71.63
|
| Rate for Payer: Cash Price |
$283.36
|
| Rate for Payer: Cash Price |
$283.36
|
| Rate for Payer: Devoted Health Medicare |
$78.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.76
|
| Rate for Payer: Health Management Network Commercial |
$401.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.63
|
|
|
PR ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
|
Professional
|
Both
|
$11,489.96
|
|
|
Service Code
|
HCPCS 47383
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$9,766.47 |
| Rate for Payer: AlohaCare Medicaid |
$439.18
|
| Rate for Payer: AlohaCare Medicare |
$397.88
|
| Rate for Payer: Cash Price |
$6,893.98
|
| Rate for Payer: Cash Price |
$6,893.98
|
| Rate for Payer: Devoted Health Medicare |
$437.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$439.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$723.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$397.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$439.18
|
| Rate for Payer: Health Management Network Commercial |
$9,766.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$477.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$477.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$397.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$439.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$397.88
|
| Rate for Payer: University Health Alliance Commercial |
$582.36
|
|
|
PR ABLATION B9 THYROID NODULE PERQ LASER W/IMG GDN
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 0673T
|
| Min. Negotiated Rate |
$207.78 |
| Max. Negotiated Rate |
$1,443.30 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$207.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$207.78
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
|
|
PR ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY
|
Professional
|
Both
|
$6,881.56
|
|
|
Service Code
|
HCPCS 50593
|
| Min. Negotiated Rate |
$396.11 |
| Max. Negotiated Rate |
$5,849.33 |
| Rate for Payer: AlohaCare Medicaid |
$450.08
|
| Rate for Payer: AlohaCare Medicare |
$396.11
|
| Rate for Payer: Cash Price |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,128.94
|
| Rate for Payer: Devoted Health Medicare |
$435.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$450.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$704.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$396.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.08
|
| Rate for Payer: Health Management Network Commercial |
$5,849.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$475.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$475.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$475.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$450.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$396.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$450.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$396.11
|
| Rate for Payer: University Health Alliance Commercial |
$596.46
|
|
|
PR ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD
|
Professional
|
Both
|
$9,688.74
|
|
|
Service Code
|
HCPCS 20983
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$8,235.43 |
| Rate for Payer: AlohaCare Medicaid |
$335.38
|
| Rate for Payer: AlohaCare Medicare |
$297.90
|
| Rate for Payer: Cash Price |
$5,813.24
|
| Rate for Payer: Cash Price |
$5,813.24
|
| Rate for Payer: Devoted Health Medicare |
$327.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$335.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$580.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$335.38
|
| Rate for Payer: Health Management Network Commercial |
$8,235.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$335.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$335.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.90
|
| Rate for Payer: University Health Alliance Commercial |
$442.53
|
|
|
PR ABLTJ 1/> LVR TUM PRQ RF
|
Professional
|
Both
|
$6,659.62
|
|
|
Service Code
|
HCPCS 47382
|
| Min. Negotiated Rate |
$628.68 |
| Max. Negotiated Rate |
$5,660.68 |
| Rate for Payer: AlohaCare Medicaid |
$717.53
|
| Rate for Payer: AlohaCare Medicare |
$631.02
|
| Rate for Payer: Cash Price |
$3,995.77
|
| Rate for Payer: Cash Price |
$3,995.77
|
| Rate for Payer: Devoted Health Medicare |
$694.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$717.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,130.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$631.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$717.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$628.68
|
| Rate for Payer: Health Management Network Commercial |
$5,660.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$757.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$757.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$717.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$631.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$717.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$631.02
|
| Rate for Payer: University Health Alliance Commercial |
$1,001.80
|
|
|
PR ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY
|
Professional
|
Both
|
$5,146.72
|
|
|
Service Code
|
HCPCS 50592
|
| Min. Negotiated Rate |
$296.27 |
| Max. Negotiated Rate |
$4,374.71 |
| Rate for Payer: AlohaCare Medicaid |
$338.40
|
| Rate for Payer: AlohaCare Medicare |
$296.27
|
| Rate for Payer: Cash Price |
$3,088.03
|
| Rate for Payer: Cash Price |
$3,088.03
|
| Rate for Payer: Devoted Health Medicare |
$325.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$338.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$530.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$338.40
|
| Rate for Payer: Health Management Network Commercial |
$4,374.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$338.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$338.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.27
|
| Rate for Payer: University Health Alliance Commercial |
$449.21
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN LXTR/PERPH NERVE
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 0441T
|
| Min. Negotiated Rate |
$3,356.65 |
| Max. Negotiated Rate |
$3,356.65 |
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Health Management Network Commercial |
$3,356.65
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV
|
Professional
|
Both
|
$13,626.00
|
|
|
Service Code
|
HCPCS 0442T
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$11,582.10 |
| Rate for Payer: Cash Price |
$8,175.60
|
| Rate for Payer: Cash Price |
$8,175.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.20
|
| Rate for Payer: Health Management Network Commercial |
$11,582.10
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN UXTR/PERPH NERVE
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 0440T
|
| Min. Negotiated Rate |
$3,356.65 |
| Max. Negotiated Rate |
$3,356.65 |
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Health Management Network Commercial |
$3,356.65
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$528.55
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$449.27 |
| Rate for Payer: AlohaCare Medicaid |
$217.89
|
| Rate for Payer: AlohaCare Medicare |
$193.80
|
| Rate for Payer: Cash Price |
$317.13
|
| Rate for Payer: Cash Price |
$317.13
|
| Rate for Payer: Devoted Health Medicare |
$213.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$217.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$217.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.24
|
| Rate for Payer: Health Management Network Commercial |
$449.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.80
|
| Rate for Payer: University Health Alliance Commercial |
$265.35
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$421.87
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$358.59 |
| Rate for Payer: AlohaCare Medicaid |
$166.96
|
| Rate for Payer: AlohaCare Medicare |
$151.44
|
| Rate for Payer: Cash Price |
$253.12
|
| Rate for Payer: Cash Price |
$253.12
|
| Rate for Payer: Devoted Health Medicare |
$166.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$166.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$166.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.58
|
| Rate for Payer: Health Management Network Commercial |
$358.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.44
|
| Rate for Payer: University Health Alliance Commercial |
$202.03
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$1,937.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$948.48 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,129.23
|
| Rate for Payer: AlohaCare Medicare |
$1,015.32
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Devoted Health Medicare |
$1,116.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,015.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.48
|
| Rate for Payer: Health Management Network Commercial |
$1,646.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,218.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,218.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,218.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,129.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,015.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,129.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,015.32
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$215.56
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$183.23 |
| Rate for Payer: AlohaCare Medicaid |
$52.81
|
| Rate for Payer: AlohaCare Medicare |
$42.67
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Devoted Health Medicare |
$46.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.88
|
| Rate for Payer: Health Management Network Commercial |
$183.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.67
|
|
|
PR ACOUSTIC REFLEX THRESHOLD
|
Professional
|
Both
|
$27.93
|
|
|
Service Code
|
HCPCS 92568
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: AlohaCare Medicaid |
$15.19
|
| Rate for Payer: AlohaCare Medicare |
$12.92
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Devoted Health Medicare |
$14.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.29
|
| Rate for Payer: Health Management Network Commercial |
$23.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.92
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$597.22 |
| Max. Negotiated Rate |
$953.70 |
| Rate for Payer: AlohaCare Medicaid |
$652.83
|
| Rate for Payer: AlohaCare Medicare |
$607.49
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Devoted Health Medicare |
$668.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$607.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$597.22
|
| Rate for Payer: Health Management Network Commercial |
$953.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$728.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$728.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$652.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$607.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$652.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$607.49
|
|
|
PR ACUPUNCTURE 1/> NDLS W/ESTIM 1ST 15 MIN
|
Professional
|
Both
|
$104.76
|
|
|
Service Code
|
HCPCS 97813
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: AlohaCare Medicare |
$33.66
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Devoted Health Medicare |
$37.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.66
|
| Rate for Payer: Health Management Network Commercial |
$89.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.66
|
|
|
PR ACUPUNCTURE 1/> NDLS W/ESTIM EACH ADDL 15 MIN
|
Professional
|
Both
|
$52.41
|
|
|
Service Code
|
HCPCS 97814
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: AlohaCare Medicare |
$21.22
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Devoted Health Medicare |
$23.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.22
|
| Rate for Payer: Health Management Network Commercial |
$44.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.22
|
|
