|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$3,044.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$1,069.74 |
| Max. Negotiated Rate |
$2,587.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$1,069.74
|
| Rate for Payer: Cash Price |
$1,826.40
|
| Rate for Payer: Cash Price |
$1,826.40
|
| Rate for Payer: Devoted Health Medicare |
$1,176.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,069.74
|
| Rate for Payer: Health Management Network Commercial |
$2,587.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,283.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,283.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,283.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,069.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,069.74
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 93455 26
|
| Min. Negotiated Rate |
$266.32 |
| Max. Negotiated Rate |
$1,092.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$266.32
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Devoted Health Medicare |
$292.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.32
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.32
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
HCPCS 93455 TC
|
| Min. Negotiated Rate |
$803.42 |
| Max. Negotiated Rate |
$2,191.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.40
|
| Rate for Payer: AlohaCare Medicare |
$803.42
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Devoted Health Medicare |
$883.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$803.42
|
| Rate for Payer: Health Management Network Commercial |
$2,191.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$964.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$964.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$964.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,092.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$803.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,092.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$803.42
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 93457 TC
|
| Min. Negotiated Rate |
$968.05 |
| Max. Negotiated Rate |
$2,632.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$968.05
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Devoted Health Medicare |
$1,064.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$968.05
|
| Rate for Payer: Health Management Network Commercial |
$2,632.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,161.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,161.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,161.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$968.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$968.05
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 93457 26
|
| Min. Negotiated Rate |
$334.47 |
| Max. Negotiated Rate |
$1,328.27 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$334.47
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.47
|
| Rate for Payer: Health Management Network Commercial |
$497.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$401.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$401.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.47
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$3,682.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$1,302.52 |
| Max. Negotiated Rate |
$3,129.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.27
|
| Rate for Payer: AlohaCare Medicare |
$1,302.52
|
| Rate for Payer: Cash Price |
$2,209.20
|
| Rate for Payer: Cash Price |
$2,209.20
|
| Rate for Payer: Devoted Health Medicare |
$1,432.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,302.52
|
| Rate for Payer: Health Management Network Commercial |
$3,129.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,563.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,563.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,563.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,302.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,302.52
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 93456 26
|
| Min. Negotiated Rate |
$297.45 |
| Max. Negotiated Rate |
$1,220.13 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$297.45
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$327.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.45
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.45
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,872.00
|
|
|
Service Code
|
HCPCS 93456 TC
|
| Min. Negotiated Rate |
$897.98 |
| Max. Negotiated Rate |
$2,441.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$897.98
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Devoted Health Medicare |
$987.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$897.98
|
| Rate for Payer: Health Management Network Commercial |
$2,441.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,077.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,077.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.98
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,393.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$1,195.43 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,220.13
|
| Rate for Payer: AlohaCare Medicare |
$1,195.43
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Devoted Health Medicare |
$1,314.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,195.43
|
| Rate for Payer: Health Management Network Commercial |
$2,884.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,434.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,434.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,434.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,220.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,195.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,220.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,195.43
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$460.41
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$391.35 |
| Rate for Payer: AlohaCare Medicaid |
$59.06
|
| Rate for Payer: AlohaCare Medicare |
$52.70
|
| Rate for Payer: Cash Price |
$276.25
|
| Rate for Payer: Cash Price |
$276.25
|
| Rate for Payer: Devoted Health Medicare |
$57.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$391.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.70
|
| Rate for Payer: University Health Alliance Commercial |
$75.78
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.59
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: AlohaCare Medicaid |
$147.43
|
| Rate for Payer: AlohaCare Medicare |
$130.29
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Devoted Health Medicare |
$143.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.26
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.29
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$1,180.14 |
| Max. Negotiated Rate |
$2,142.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,475.79
|
| Rate for Payer: AlohaCare Medicare |
$1,259.90
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Devoted Health Medicare |
$1,385.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,259.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,180.14
|
| Rate for Payer: Health Management Network Commercial |
$2,142.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,511.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,511.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,511.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,475.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,259.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,475.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,259.90
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$422.76 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: AlohaCare Medicaid |
$867.91
|
| Rate for Payer: AlohaCare Medicare |
$769.32
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Devoted Health Medicare |
$846.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$769.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$422.76
|
| Rate for Payer: Health Management Network Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$923.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$923.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$923.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$867.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$769.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$867.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$769.32
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,201.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$841.62 |
| Max. Negotiated Rate |
$1,870.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,296.15
|
| Rate for Payer: AlohaCare Medicare |
$1,153.02
|
| Rate for Payer: Cash Price |
$1,320.60
|
| Rate for Payer: Cash Price |
$1,320.60
|
| Rate for Payer: Devoted Health Medicare |
$1,268.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,153.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$841.62
|
| Rate for Payer: Health Management Network Commercial |
$1,870.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,383.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,383.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,383.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,153.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,153.02
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$114.62
|
| Rate for Payer: AlohaCare Medicare |
$102.03
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$112.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.03
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.03
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$264.34
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$224.69 |
| Rate for Payer: AlohaCare Medicaid |
$81.39
|
| Rate for Payer: AlohaCare Medicare |
$73.96
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$81.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$146.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$224.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.96
|
| Rate for Payer: University Health Alliance Commercial |
$105.16
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$190.42
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$161.86 |
| Rate for Payer: AlohaCare Medicaid |
$52.28
|
| Rate for Payer: AlohaCare Medicare |
$47.28
|
| Rate for Payer: Cash Price |
$114.25
|
| Rate for Payer: Cash Price |
$114.25
|
| Rate for Payer: Devoted Health Medicare |
$52.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.84
|
| Rate for Payer: Health Management Network Commercial |
$161.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.28
|
| Rate for Payer: University Health Alliance Commercial |
$67.83
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$173.23
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: AlohaCare Medicaid |
$39.17
|
| Rate for Payer: AlohaCare Medicare |
$36.71
|
| Rate for Payer: Cash Price |
$103.94
|
| Rate for Payer: Cash Price |
$103.94
|
| Rate for Payer: Devoted Health Medicare |
$40.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.84
|
| Rate for Payer: Health Management Network Commercial |
$147.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.71
|
|
|
PR CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE
|
Professional
|
Both
|
$163.10
|
|
|
Service Code
|
HCPCS 64650
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: AlohaCare Medicaid |
$40.84
|
| Rate for Payer: AlohaCare Medicare |
$32.82
|
| Rate for Payer: Cash Price |
$97.86
|
| Rate for Payer: Cash Price |
$97.86
|
| Rate for Payer: Devoted Health Medicare |
$36.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$62.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.04
|
| Rate for Payer: Health Management Network Commercial |
$138.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.82
|
| Rate for Payer: University Health Alliance Commercial |
$50.41
|
|
|
PR CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY
|
Professional
|
Both
|
$190.94
|
|
|
Service Code
|
HCPCS 64653
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: AlohaCare Medicaid |
$51.20
|
| Rate for Payer: AlohaCare Medicare |
$41.89
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Devoted Health Medicare |
$46.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.20
|
| Rate for Payer: Health Management Network Commercial |
$162.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.89
|
| Rate for Payer: University Health Alliance Commercial |
$68.31
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$258.20
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$97.03 |
| Max. Negotiated Rate |
$219.47 |
| Rate for Payer: AlohaCare Medicaid |
$108.83
|
| Rate for Payer: AlohaCare Medicare |
$97.03
|
| Rate for Payer: Cash Price |
$154.92
|
| Rate for Payer: Cash Price |
$154.92
|
| Rate for Payer: Devoted Health Medicare |
$106.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$168.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.18
|
| Rate for Payer: Health Management Network Commercial |
$219.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.03
|
| Rate for Payer: University Health Alliance Commercial |
$135.26
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$255.08
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$216.82 |
| Rate for Payer: AlohaCare Medicaid |
$118.25
|
| Rate for Payer: AlohaCare Medicare |
$111.20
|
| Rate for Payer: Cash Price |
$153.05
|
| Rate for Payer: Cash Price |
$153.05
|
| Rate for Payer: Devoted Health Medicare |
$122.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.25
|
| Rate for Payer: Health Management Network Commercial |
$216.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$133.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.20
|
| Rate for Payer: University Health Alliance Commercial |
$146.18
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$277.73
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$104.39 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: AlohaCare Medicaid |
$120.01
|
| Rate for Payer: AlohaCare Medicare |
$104.39
|
| Rate for Payer: Cash Price |
$166.64
|
| Rate for Payer: Cash Price |
$166.64
|
| Rate for Payer: Devoted Health Medicare |
$114.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$188.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$236.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.39
|
| Rate for Payer: University Health Alliance Commercial |
$148.58
|
|
|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$261.36
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$111.37 |
| Max. Negotiated Rate |
$222.16 |
| Rate for Payer: AlohaCare Medicaid |
$124.83
|
| Rate for Payer: AlohaCare Medicare |
$111.37
|
| Rate for Payer: Cash Price |
$156.82
|
| Rate for Payer: Cash Price |
$156.82
|
| Rate for Payer: Devoted Health Medicare |
$122.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.58
|
| Rate for Payer: Health Management Network Commercial |
$222.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$133.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.37
|
| Rate for Payer: University Health Alliance Commercial |
$154.29
|
|
