|
PR ACUPUNCTURE 1/> NDLS W/O ESTIM 1ST 15 MIN
|
Professional
|
Both
|
$89.51
|
|
|
Service Code
|
HCPCS 97810
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: AlohaCare Medicare |
$27.60
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Devoted Health Medicare |
$30.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.60
|
| Rate for Payer: Health Management Network Commercial |
$76.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.60
|
|
|
PR ACUPUNCTURE 1/> NDLS W/O ESTIM EACH ADDL 15 MIN
|
Professional
|
Both
|
$51.84
|
|
|
Service Code
|
HCPCS 97811
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: AlohaCare Medicare |
$20.88
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Devoted Health Medicare |
$22.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.88
|
| Rate for Payer: Health Management Network Commercial |
$44.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.88
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: AlohaCare Medicaid |
$227.45
|
| Rate for Payer: AlohaCare Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$223.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$182.00
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.28
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: AlohaCare Medicaid |
$247.88
|
| Rate for Payer: AlohaCare Medicare |
$221.92
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Devoted Health Medicare |
$244.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.48
|
| Rate for Payer: Health Management Network Commercial |
$360.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.92
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: AlohaCare Medicaid |
$260.34
|
| Rate for Payer: AlohaCare Medicare |
$230.18
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Devoted Health Medicare |
$253.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.12
|
| Rate for Payer: Health Management Network Commercial |
$379.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.18
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: AlohaCare Medicaid |
$213.12
|
| Rate for Payer: AlohaCare Medicare |
$191.35
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Devoted Health Medicare |
$210.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.70
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.35
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,242.59
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$380.90 |
| Max. Negotiated Rate |
$1,056.20 |
| Rate for Payer: AlohaCare Medicaid |
$527.45
|
| Rate for Payer: AlohaCare Medicare |
$480.29
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Devoted Health Medicare |
$528.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$527.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$805.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$527.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.90
|
| Rate for Payer: Health Management Network Commercial |
$1,056.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$576.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$576.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$527.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$527.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.29
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,584.98
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$406.38 |
| Max. Negotiated Rate |
$1,347.23 |
| Rate for Payer: AlohaCare Medicaid |
$676.10
|
| Rate for Payer: AlohaCare Medicare |
$614.79
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Devoted Health Medicare |
$676.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$676.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,039.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$614.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$676.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.38
|
| Rate for Payer: Health Management Network Commercial |
$1,347.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$737.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$737.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$737.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$676.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$614.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$676.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$614.79
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$2,063.11
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$779.02 |
| Max. Negotiated Rate |
$1,753.64 |
| Rate for Payer: AlohaCare Medicaid |
$893.48
|
| Rate for Payer: AlohaCare Medicare |
$779.02
|
| Rate for Payer: Cash Price |
$1,237.87
|
| Rate for Payer: Cash Price |
$1,237.87
|
| Rate for Payer: Devoted Health Medicare |
$856.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$893.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,376.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$893.48
|
| Rate for Payer: Health Management Network Commercial |
$1,753.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$934.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$934.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$934.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$893.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.02
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,715.94
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$669.89 |
| Max. Negotiated Rate |
$1,458.55 |
| Rate for Payer: AlohaCare Medicaid |
$793.63
|
| Rate for Payer: AlohaCare Medicare |
$669.89
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Devoted Health Medicare |
$736.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$793.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,211.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$793.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$756.86
|
| Rate for Payer: Health Management Network Commercial |
$1,458.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$793.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.89
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,638.23
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$491.92 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: AlohaCare Medicaid |
$738.69
|
| Rate for Payer: AlohaCare Medicare |
$637.43
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Devoted Health Medicare |
$701.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$738.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,129.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$738.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$491.92
|
| Rate for Payer: Health Management Network Commercial |
$1,392.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$764.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$738.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$738.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.43
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,852.15
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$673.40 |
| Max. Negotiated Rate |
$1,574.33 |
| Rate for Payer: AlohaCare Medicaid |
$853.08
|
| Rate for Payer: AlohaCare Medicare |
$718.48
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Devoted Health Medicare |
$790.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$853.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,302.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$718.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$853.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$673.40
|
| Rate for Payer: Health Management Network Commercial |
$1,574.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$862.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$853.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$718.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$853.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$718.48
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$391.28
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$332.59 |
| Rate for Payer: AlohaCare Medicaid |
$212.97
|
| Rate for Payer: AlohaCare Medicare |
$178.78
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Devoted Health Medicare |
$196.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.78
|
| Rate for Payer: Health Management Network Commercial |
$332.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.78
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,338.56
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$459.68 |
| Max. Negotiated Rate |
$1,137.78 |
| Rate for Payer: AlohaCare Medicaid |
$596.14
|
| Rate for Payer: AlohaCare Medicare |
$522.98
|
| Rate for Payer: Cash Price |
$803.14
|
| Rate for Payer: Cash Price |
$803.14
|
| Rate for Payer: Devoted Health Medicare |
$575.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$596.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$906.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$596.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$459.68
|
| Rate for Payer: Health Management Network Commercial |
$1,137.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$596.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$596.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.98
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$1,428.24
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: AlohaCare Medicaid |
$694.94
|
| Rate for Payer: AlohaCare Medicare |
$590.94
|
| Rate for Payer: Cash Price |
$856.94
|
| Rate for Payer: Cash Price |
$856.94
|
| Rate for Payer: Devoted Health Medicare |
$650.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$694.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,060.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$590.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$694.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.38
|
| Rate for Payer: Health Management Network Commercial |
$1,214.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$709.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$709.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$709.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$694.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$694.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.94
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,424.48
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$562.59 |
| Max. Negotiated Rate |
$1,210.81 |
| Rate for Payer: AlohaCare Medicaid |
$651.80
|
| Rate for Payer: AlohaCare Medicare |
$562.59
|
| Rate for Payer: Cash Price |
$854.69
|
| Rate for Payer: Cash Price |
$854.69
|
| Rate for Payer: Devoted Health Medicare |
$618.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$651.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$994.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$562.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$651.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$572.52
|
| Rate for Payer: Health Management Network Commercial |
$1,210.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$675.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$675.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$651.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$651.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.59
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: AlohaCare Medicaid |
$469.38
|
| Rate for Payer: AlohaCare Medicare |
$442.15
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Devoted Health Medicare |
$486.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.84
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$530.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$530.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$469.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$469.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.15
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$56.93
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$48.39 |
| Rate for Payer: AlohaCare Medicaid |
$14.77
|
| Rate for Payer: AlohaCare Medicare |
$32.53
|
| Rate for Payer: Cash Price |
$34.16
|
| Rate for Payer: Cash Price |
$34.16
|
| Rate for Payer: Devoted Health Medicare |
$35.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.53
|
| Rate for Payer: Health Management Network Commercial |
$48.39
|
| 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 |
$14.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.53
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$46.83
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$39.81 |
| Rate for Payer: AlohaCare Medicaid |
$12.92
|
| Rate for Payer: AlohaCare Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Devoted Health Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.76
|
| Rate for Payer: Health Management Network Commercial |
$39.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.76
|
|
|
PR ADM OF PA/N ASSESS 5-15 M
|
Professional
|
Both
|
$38.12
|
|
|
Service Code
|
HCPCS G0136
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.24
|
| Rate for Payer: Health Management Network Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.10
|
| Rate for Payer: University Health Alliance Commercial |
$8.98
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$157.85
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: AlohaCare Medicaid |
$76.28
|
| Rate for Payer: AlohaCare Medicare |
$66.27
|
| Rate for Payer: Cash Price |
$94.71
|
| Rate for Payer: Cash Price |
$94.71
|
| Rate for Payer: Devoted Health Medicare |
$72.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$76.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.40
|
| Rate for Payer: Health Management Network Commercial |
$134.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.27
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$150.34
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$85.91 |
| Max. Negotiated Rate |
$127.79 |
| Rate for Payer: AlohaCare Medicaid |
$88.91
|
| Rate for Payer: AlohaCare Medicare |
$85.91
|
| Rate for Payer: Cash Price |
$90.20
|
| Rate for Payer: Cash Price |
$90.20
|
| Rate for Payer: Devoted Health Medicare |
$94.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.91
|
| Rate for Payer: Health Management Network Commercial |
$127.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.91
|
|
