|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$148.50
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Devoted Health Medicare |
$28.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.64
|
| Rate for Payer: Health Management Network Commercial |
$126.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$39.85
|
|
|
PR BLEPHAROPLASTY LOWER EYELID
|
Professional
|
Both
|
$1,105.77
|
|
|
Service Code
|
HCPCS 15820
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: AlohaCare Medicaid |
$551.38
|
| Rate for Payer: AlohaCare Medicare |
$475.40
|
| Rate for Payer: Cash Price |
$663.46
|
| Rate for Payer: Cash Price |
$663.46
|
| Rate for Payer: Devoted Health Medicare |
$522.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$551.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$551.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.30
|
| Rate for Payer: Health Management Network Commercial |
$939.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$570.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$570.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$551.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$551.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.40
|
| Rate for Payer: University Health Alliance Commercial |
$620.30
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$1,187.44
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$385.58 |
| Max. Negotiated Rate |
$1,009.32 |
| Rate for Payer: AlohaCare Medicaid |
$585.01
|
| Rate for Payer: AlohaCare Medicare |
$507.27
|
| Rate for Payer: Cash Price |
$712.46
|
| Rate for Payer: Cash Price |
$712.46
|
| Rate for Payer: Devoted Health Medicare |
$558.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$585.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$585.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.58
|
| Rate for Payer: Health Management Network Commercial |
$1,009.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$585.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$585.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.27
|
| Rate for Payer: University Health Alliance Commercial |
$661.92
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$544.37
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$462.71 |
| Rate for Payer: AlohaCare Medicaid |
$123.62
|
| Rate for Payer: AlohaCare Medicare |
$108.27
|
| Rate for Payer: Cash Price |
$326.62
|
| Rate for Payer: Cash Price |
$326.62
|
| Rate for Payer: Devoted Health Medicare |
$119.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$187.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$462.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.27
|
| Rate for Payer: University Health Alliance Commercial |
$158.34
|
|
|
PR BLUE LIGHT CYSTO IMAG AGENT
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS C9738
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$239.03 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: AlohaCare Medicaid |
$275.04
|
| Rate for Payer: AlohaCare Medicare |
$239.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Devoted Health Medicare |
$262.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.62
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$286.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.03
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$753.74
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$640.68 |
| Rate for Payer: AlohaCare Medicaid |
$181.49
|
| Rate for Payer: AlohaCare Medicare |
$160.31
|
| Rate for Payer: Cash Price |
$452.24
|
| Rate for Payer: Cash Price |
$452.24
|
| Rate for Payer: Devoted Health Medicare |
$176.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$605.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$181.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.88
|
| Rate for Payer: Health Management Network Commercial |
$640.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.31
|
| Rate for Payer: University Health Alliance Commercial |
$240.53
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$563.68 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: AlohaCare Medicaid |
$640.04
|
| Rate for Payer: AlohaCare Medicare |
$579.88
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Devoted Health Medicare |
$637.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$579.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$563.68
|
| Rate for Payer: Health Management Network Commercial |
$935.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$695.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$695.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$640.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$579.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$640.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$579.88
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$3,757.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,549.08 |
| Max. Negotiated Rate |
$3,193.45 |
| Rate for Payer: AlohaCare Medicaid |
$2,187.95
|
| Rate for Payer: AlohaCare Medicare |
$1,879.07
|
| Rate for Payer: Cash Price |
$2,254.20
|
| Rate for Payer: Cash Price |
$2,254.20
|
| Rate for Payer: Devoted Health Medicare |
$2,066.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,879.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,549.08
|
| Rate for Payer: Health Management Network Commercial |
$3,193.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,254.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,254.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,187.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,879.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,187.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,879.07
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$3,494.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$1,474.20 |
| Max. Negotiated Rate |
$2,969.90 |
| Rate for Payer: AlohaCare Medicaid |
$2,035.02
|
| Rate for Payer: AlohaCare Medicare |
$1,750.88
|
| Rate for Payer: Cash Price |
$2,096.40
|
| Rate for Payer: Cash Price |
$2,096.40
|
| Rate for Payer: Devoted Health Medicare |
$1,925.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,750.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network Commercial |
$2,969.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,101.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,101.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,101.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,035.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,750.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,035.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,750.88
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,562.80 |
| Max. Negotiated Rate |
$2,625.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,796.92
|
| Rate for Payer: AlohaCare Medicare |
$1,562.80
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Devoted Health Medicare |
$1,719.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,562.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,767.74
|
| Rate for Payer: Health Management Network Commercial |
$2,625.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,875.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,875.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,875.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,796.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,562.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,796.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,562.80
|
|
|
PR BREAST RECONSTRUCTION W/FREE FLAP
|
Professional
|
Both
|
$4,700.00
|
|
|
Service Code
|
HCPCS 19364
|
| Min. Negotiated Rate |
$1,716.78 |
| Max. Negotiated Rate |
$3,995.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,738.67
|
| Rate for Payer: AlohaCare Medicare |
$2,356.29
|
| Rate for Payer: Cash Price |
$2,820.00
|
| Rate for Payer: Cash Price |
$2,820.00
|
| Rate for Payer: Devoted Health Medicare |
$2,591.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,356.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,716.78
|
| Rate for Payer: Health Management Network Commercial |
$3,995.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,827.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,827.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,827.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,738.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,356.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,738.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,356.29
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$2,722.00
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$1,155.96 |
| Max. Negotiated Rate |
$2,313.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,584.19
|
| Rate for Payer: AlohaCare Medicare |
$1,387.29
|
| Rate for Payer: Cash Price |
$1,633.20
|
| Rate for Payer: Cash Price |
$1,633.20
|
| Rate for Payer: Devoted Health Medicare |
$1,526.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,387.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,155.96
|
| Rate for Payer: Health Management Network Commercial |
$2,313.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,664.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,664.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,664.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,584.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,387.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,584.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,387.29
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,921.00
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$987.93 |
| Max. Negotiated Rate |
$1,632.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,117.43
|
| Rate for Payer: AlohaCare Medicare |
$987.93
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Devoted Health Medicare |
$1,086.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$987.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,166.62
|
| Rate for Payer: Health Management Network Commercial |
$1,632.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,185.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,185.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,185.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,117.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$987.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,117.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$987.93
|
|
|
PR BRIEF CHKIN BY MD/QHP, 11-20
|
Professional
|
Both
|
$51.19
|
|
|
Service Code
|
HCPCS G2252
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: AlohaCare Medicaid |
$25.24
|
| Rate for Payer: AlohaCare Medicare |
$22.41
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Devoted Health Medicare |
$24.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.59
|
| Rate for Payer: Health Management Network Commercial |
$43.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.41
|
|
|
PR BRIEF COMMUNICATION TECH-BSD SVC EST PT 5-10 MIN
|
Professional
|
Both
|
$31.50
|
|
|
Service Code
|
HCPCS 98016
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: AlohaCare Medicaid |
$0.01
|
| Rate for Payer: AlohaCare Medicare |
$13.07
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Devoted Health Medicare |
$14.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.07
|
| Rate for Payer: Health Management Network Commercial |
$26.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.07
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 94060 26
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.27
|
| Rate for Payer: AlohaCare Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$11.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.42
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.63
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: AlohaCare Medicaid |
$43.27
|
| Rate for Payer: AlohaCare Medicare |
$48.04
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Devoted Health Medicare |
$52.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.42
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.04
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: AlohaCare Medicaid |
$43.27
|
| Rate for Payer: AlohaCare Medicare |
$37.41
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$41.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.42
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.41
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$574.46
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$488.29 |
| Rate for Payer: AlohaCare Medicaid |
$130.47
|
| Rate for Payer: AlohaCare Medicare |
$119.39
|
| Rate for Payer: Cash Price |
$344.68
|
| Rate for Payer: Cash Price |
$344.68
|
| Rate for Payer: Devoted Health Medicare |
$131.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$329.16
|
| Rate for Payer: Health Management Network Commercial |
$488.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.39
|
| Rate for Payer: University Health Alliance Commercial |
$174.51
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$532.68
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$452.78 |
| Rate for Payer: AlohaCare Medicaid |
$130.55
|
| Rate for Payer: AlohaCare Medicare |
$119.82
|
| Rate for Payer: Cash Price |
$319.61
|
| Rate for Payer: Cash Price |
$319.61
|
| Rate for Payer: Devoted Health Medicare |
$131.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$204.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$231.14
|
| Rate for Payer: Health Management Network Commercial |
$452.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.82
|
| Rate for Payer: University Health Alliance Commercial |
$172.86
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$541.89
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$121.29 |
| Max. Negotiated Rate |
$460.61 |
| Rate for Payer: AlohaCare Medicaid |
$132.19
|
| Rate for Payer: AlohaCare Medicare |
$121.29
|
| Rate for Payer: Cash Price |
$325.13
|
| Rate for Payer: Cash Price |
$325.13
|
| Rate for Payer: Devoted Health Medicare |
$133.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$208.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network Commercial |
$460.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.29
|
| Rate for Payer: University Health Alliance Commercial |
$176.31
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 94070 TC
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$96.35 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$46.34
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Devoted Health Medicare |
$50.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.35
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.34
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$75.74
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$83.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.35
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.74
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 94070 26
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$96.35 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$29.40
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$32.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.35
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.40
|
|
