|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$99.25
|
| Rate for Payer: AlohaCare Medicare |
$98.55
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$108.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.86
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.55
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$548.59
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$234.87 |
| Max. Negotiated Rate |
$466.30 |
| Rate for Payer: AlohaCare Medicaid |
$265.89
|
| Rate for Payer: AlohaCare Medicare |
$234.87
|
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Devoted Health Medicare |
$258.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$265.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$411.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$265.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.98
|
| Rate for Payer: Health Management Network Commercial |
$466.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$281.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$265.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.87
|
| Rate for Payer: University Health Alliance Commercial |
$327.66
|
|
|
PR CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE
|
Professional
|
Both
|
$252.44
|
|
|
Service Code
|
HCPCS 49465
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$214.57 |
| Rate for Payer: AlohaCare Medicaid |
$29.79
|
| Rate for Payer: AlohaCare Medicare |
$25.38
|
| Rate for Payer: Cash Price |
$151.46
|
| Rate for Payer: Cash Price |
$151.46
|
| Rate for Payer: Devoted Health Medicare |
$27.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.79
|
| Rate for Payer: Health Management Network Commercial |
$214.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.38
|
| Rate for Payer: University Health Alliance Commercial |
$39.55
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$508.53
|
|
|
Service Code
|
HCPCS 30903
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: AlohaCare Medicaid |
$75.24
|
| Rate for Payer: AlohaCare Medicare |
$67.29
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Devoted Health Medicare |
$74.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$432.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.29
|
| Rate for Payer: University Health Alliance Commercial |
$93.56
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Professional
|
Both
|
$314.88
|
|
|
Service Code
|
HCPCS 30901
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$267.65 |
| Rate for Payer: AlohaCare Medicaid |
$55.46
|
| Rate for Payer: AlohaCare Medicare |
$48.15
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Devoted Health Medicare |
$52.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$86.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$267.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.15
|
| Rate for Payer: University Health Alliance Commercial |
$68.69
|
|
|
PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,484.65
|
|
|
Service Code
|
HCPCS 49446
|
| Min. Negotiated Rate |
$123.39 |
| Max. Negotiated Rate |
$1,261.95 |
| Rate for Payer: AlohaCare Medicaid |
$141.30
|
| Rate for Payer: AlohaCare Medicare |
$123.39
|
| Rate for Payer: Cash Price |
$890.79
|
| Rate for Payer: Cash Price |
$890.79
|
| Rate for Payer: Devoted Health Medicare |
$135.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.30
|
| Rate for Payer: Health Management Network Commercial |
$1,261.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.39
|
|
|
PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ
|
Professional
|
Both
|
$1,679.95
|
|
|
Service Code
|
HCPCS 50434
|
| Min. Negotiated Rate |
$165.12 |
| Max. Negotiated Rate |
$1,427.96 |
| Rate for Payer: AlohaCare Medicaid |
$186.23
|
| Rate for Payer: AlohaCare Medicare |
$165.12
|
| Rate for Payer: Cash Price |
$1,007.97
|
| Rate for Payer: Cash Price |
$1,007.97
|
| Rate for Payer: Devoted Health Medicare |
$181.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$308.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$186.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,034.80
|
| Rate for Payer: Health Management Network Commercial |
$1,427.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.12
|
| Rate for Payer: University Health Alliance Commercial |
$247.88
|
|
|
PR CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH
|
Professional
|
Both
|
$1,644.54
|
|
|
Service Code
|
HCPCS 47535
|
| Min. Negotiated Rate |
$166.91 |
| Max. Negotiated Rate |
$1,397.86 |
| Rate for Payer: AlohaCare Medicaid |
$189.82
|
| Rate for Payer: AlohaCare Medicare |
$166.91
|
| Rate for Payer: Cash Price |
$986.72
|
| Rate for Payer: Cash Price |
$986.72
|
| Rate for Payer: Devoted Health Medicare |
$183.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$339.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,271.14
|
| Rate for Payer: Health Management Network Commercial |
$1,397.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.91
|
| Rate for Payer: University Health Alliance Commercial |
$254.04
|
|
|
PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$2,897.00
|
|
|
Service Code
|
HCPCS 27132
|
| Min. Negotiated Rate |
$1,465.88 |
| Max. Negotiated Rate |
$2,462.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,687.72
|
| Rate for Payer: AlohaCare Medicare |
$1,496.50
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Devoted Health Medicare |
$1,646.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,496.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,465.88
|
| Rate for Payer: Health Management Network Commercial |
$2,462.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,795.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,795.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,795.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,687.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,496.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,687.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,496.50
|
|
|
PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG
|
Professional
|
Both
|
$1,565.76
|
|
|
Service Code
|
HCPCS 32408
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$1,330.90 |
| Rate for Payer: AlohaCare Medicaid |
$148.55
|
| Rate for Payer: AlohaCare Medicare |
$127.97
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Cash Price |
$939.46
|
| Rate for Payer: Devoted Health Medicare |
$140.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$235.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,086.28
|
| Rate for Payer: Health Management Network Commercial |
$1,330.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.97
|
| Rate for Payer: University Health Alliance Commercial |
$184.28
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,116.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$503.36 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: AlohaCare Medicaid |
$650.77
|
| Rate for Payer: AlohaCare Medicare |
$586.31
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Devoted Health Medicare |
$644.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$586.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$503.36
|
| Rate for Payer: Health Management Network Commercial |
$948.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$703.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$703.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$703.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$586.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$650.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$586.31
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,453.85
|
| Rate for Payer: AlohaCare Medicare |
$1,334.03
|
| Rate for Payer: Cash Price |
$1,498.80
|
| Rate for Payer: Cash Price |
$1,498.80
|
| Rate for Payer: Devoted Health Medicare |
$1,467.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,334.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$611.00
|
| Rate for Payer: Health Management Network Commercial |
$2,123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,600.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,600.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,600.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,453.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,334.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,453.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,334.03
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: AlohaCare Medicaid |
$6.43
|
| Rate for Payer: AlohaCare Medicare |
$15.27
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.27
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$145.23
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$43.87 |
| Max. Negotiated Rate |
$123.45 |
| Rate for Payer: AlohaCare Medicare |
$43.87
|
| Rate for Payer: Cash Price |
$87.14
|
| Rate for Payer: Cash Price |
$87.14
|
| Rate for Payer: Devoted Health Medicare |
$48.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.08
|
| Rate for Payer: Health Management Network Commercial |
$123.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.87
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 0055T
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.76
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 20985
|
| Min. Negotiated Rate |
$120.41 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: AlohaCare Medicaid |
$142.08
|
| Rate for Payer: AlohaCare Medicare |
$120.41
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Devoted Health Medicare |
$132.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.41
|
|
|
PR CRANIECTOMY W/EXCISION TUMOR/OTH BONE LESION SKL
|
Professional
|
Both
|
$2,218.00
|
|
|
Service Code
|
HCPCS 61500
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$1,885.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.43
|
| Rate for Payer: AlohaCare Medicare |
$1,173.61
|
| Rate for Payer: Cash Price |
$1,330.80
|
| Rate for Payer: Cash Price |
$1,330.80
|
| Rate for Payer: Devoted Health Medicare |
$1,290.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,173.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,457.30
|
| Rate for Payer: Health Management Network Commercial |
$1,885.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,408.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,408.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,408.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,173.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,173.61
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Professional
|
Both
|
$240.98
|
|
|
Service Code
|
HCPCS 99292
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$204.83 |
| Rate for Payer: AlohaCare Medicaid |
$105.97
|
| Rate for Payer: AlohaCare Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Devoted Health Medicare |
$109.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.90
|
| Rate for Payer: Health Management Network Commercial |
$204.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.35
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Professional
|
Both
|
$563.71
|
|
|
Service Code
|
HCPCS 99291
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$479.15 |
| Rate for Payer: AlohaCare Medicaid |
$210.80
|
| Rate for Payer: AlohaCare Medicare |
$197.18
|
| Rate for Payer: Cash Price |
$338.23
|
| Rate for Payer: Cash Price |
$338.23
|
| Rate for Payer: Devoted Health Medicare |
$216.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$210.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$210.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$251.64
|
| Rate for Payer: Health Management Network Commercial |
$479.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.18
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 99466
|
| Min. Negotiated Rate |
$202.24 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: AlohaCare Medicaid |
$232.54
|
| Rate for Payer: AlohaCare Medicare |
$202.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Devoted Health Medicare |
$222.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.24
|
| Rate for Payer: Health Management Network Commercial |
$334.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.24
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 99467
|
| Min. Negotiated Rate |
$101.29 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$116.72
|
| Rate for Payer: AlohaCare Medicare |
$101.29
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$111.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.29
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.29
|
|
|
PR CRNEC/CRNOT HMTMA SUPRATENTORIAL XDRL/SUBDURAL
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 61312
|
| Min. Negotiated Rate |
$1,432.08 |
| Max. Negotiated Rate |
$2,929.95 |
| Rate for Payer: AlohaCare Medicaid |
$2,015.09
|
| Rate for Payer: AlohaCare Medicare |
$1,914.76
|
| Rate for Payer: Cash Price |
$2,068.20
|
| Rate for Payer: Cash Price |
$2,068.20
|
| Rate for Payer: Devoted Health Medicare |
$2,106.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,914.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,432.08
|
| Rate for Payer: Health Management Network Commercial |
$2,929.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,297.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,297.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,297.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,015.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,914.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,015.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,914.76
|
|
|
PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 36825
|
| Min. Negotiated Rate |
$606.58 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: AlohaCare Medicaid |
$752.55
|
| Rate for Payer: AlohaCare Medicare |
$690.52
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Devoted Health Medicare |
$759.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$690.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.58
|
| Rate for Payer: Health Management Network Commercial |
$1,088.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$828.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$828.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$828.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$752.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$690.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$752.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$690.52
|
|
|
PR CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 36830
|
| Min. Negotiated Rate |
$580.83 |
| Max. Negotiated Rate |
$914.60 |
| Rate for Payer: AlohaCare Medicaid |
$631.08
|
| Rate for Payer: AlohaCare Medicare |
$580.83
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Devoted Health Medicare |
$638.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$851.50
|
| Rate for Payer: Health Management Network Commercial |
$914.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$697.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$697.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$697.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$631.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$631.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.83
|
|
|
PR CSTO W/TRURL RESCJ/INC EJACULATORY DUXS
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 52402
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: AlohaCare Medicaid |
$260.05
|
| Rate for Payer: AlohaCare Medicare |
$226.79
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Devoted Health Medicare |
$249.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.79
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.79
|
|
