|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 95957 TC
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$236.23
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Devoted Health Medicare |
$259.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$236.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$600.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$283.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$283.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.23
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 95957 26
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$324.41 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$105.31
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$115.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.31
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$148.72
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$126.41 |
| Rate for Payer: AlohaCare Medicaid |
$42.14
|
| Rate for Payer: AlohaCare Medicare |
$37.89
|
| Rate for Payer: Cash Price |
$89.23
|
| Rate for Payer: Cash Price |
$89.23
|
| Rate for Payer: Devoted Health Medicare |
$41.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.88
|
| Rate for Payer: Health Management Network Commercial |
$126.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.89
|
| Rate for Payer: University Health Alliance Commercial |
$54.79
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$544.92
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$210.36 |
| Max. Negotiated Rate |
$463.18 |
| Rate for Payer: AlohaCare Medicaid |
$240.48
|
| Rate for Payer: AlohaCare Medicare |
$210.36
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Devoted Health Medicare |
$231.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$240.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$374.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$210.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$240.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.36
|
| Rate for Payer: University Health Alliance Commercial |
$316.81
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$167.09
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$142.03 |
| Rate for Payer: AlohaCare Medicaid |
$62.97
|
| Rate for Payer: AlohaCare Medicare |
$55.61
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Devoted Health Medicare |
$61.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$62.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$97.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$142.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.61
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$166.51
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$141.53 |
| Rate for Payer: AlohaCare Medicaid |
$53.22
|
| Rate for Payer: AlohaCare Medicare |
$47.68
|
| Rate for Payer: Cash Price |
$99.91
|
| Rate for Payer: Cash Price |
$99.91
|
| Rate for Payer: Devoted Health Medicare |
$52.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.96
|
| Rate for Payer: Health Management Network Commercial |
$141.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.68
|
| Rate for Payer: University Health Alliance Commercial |
$69.37
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: AlohaCare Medicaid |
$62.81
|
| Rate for Payer: AlohaCare Medicare |
$54.72
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Devoted Health Medicare |
$60.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.70
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.72
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.13
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$2,806.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,502.84 |
| Max. Negotiated Rate |
$2,515.28 |
| Rate for Payer: AlohaCare Medicaid |
$1,643.41
|
| Rate for Payer: AlohaCare Medicare |
$1,502.84
|
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Devoted Health Medicare |
$1,653.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,502.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,686.88
|
| Rate for Payer: Health Management Network Commercial |
$2,385.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,803.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,803.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,803.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,643.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,502.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,643.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,502.84
|
| Rate for Payer: University Health Alliance Commercial |
$2,515.28
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,484.63 |
| Max. Negotiated Rate |
$2,459.38 |
| Rate for Payer: AlohaCare Medicaid |
$1,608.65
|
| Rate for Payer: AlohaCare Medicare |
$1,484.63
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Devoted Health Medicare |
$1,633.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,484.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,779.96
|
| Rate for Payer: Health Management Network Commercial |
$2,329.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,781.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,781.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,781.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,608.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,484.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,608.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,484.63
|
| Rate for Payer: University Health Alliance Commercial |
$2,459.38
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$1,427.05 |
| Rate for Payer: AlohaCare Medicaid |
$952.01
|
| Rate for Payer: AlohaCare Medicare |
$869.10
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Devoted Health Medicare |
$956.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$869.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$717.60
|
| Rate for Payer: Health Management Network Commercial |
$1,376.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,042.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,042.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,042.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$952.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$869.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$952.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$869.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,427.05
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$854.10 |
| Max. Negotiated Rate |
$1,476.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,018.62
|
| Rate for Payer: AlohaCare Medicare |
$936.73
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Devoted Health Medicare |
$1,030.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$936.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$854.10
|
| Rate for Payer: Health Management Network Commercial |
$1,476.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,124.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,124.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,124.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,018.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$936.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,018.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$936.73
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$2,208.00
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$1,010.62 |
| Max. Negotiated Rate |
$1,876.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,288.91
|
| Rate for Payer: AlohaCare Medicare |
$1,191.68
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Devoted Health Medicare |
$1,310.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,191.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,010.62
|
| Rate for Payer: Health Management Network Commercial |
$1,876.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,430.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,430.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,430.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,288.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,191.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,288.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,191.68
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$1,883.44 |
| Max. Negotiated Rate |
$3,662.69 |
| Rate for Payer: AlohaCare Medicaid |
$2,403.13
|
| Rate for Payer: AlohaCare Medicare |
$2,140.90
|
| Rate for Payer: Cash Price |
$2,461.20
|
| Rate for Payer: Cash Price |
$2,461.20
|
| Rate for Payer: Devoted Health Medicare |
$2,354.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,140.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,883.44
|
| Rate for Payer: Health Management Network Commercial |
$3,486.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,569.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,569.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,569.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,403.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,140.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,403.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,140.90
|
| Rate for Payer: University Health Alliance Commercial |
$3,662.69
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$3,405.00
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$1,737.32 |
| Max. Negotiated Rate |
$2,894.25 |
| Rate for Payer: AlohaCare Medicaid |
$2,050.65
|
| Rate for Payer: AlohaCare Medicare |
$1,838.12
|
| Rate for Payer: Cash Price |
$2,043.00
|
| Rate for Payer: Cash Price |
$2,043.00
|
| Rate for Payer: Devoted Health Medicare |
$2,021.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,838.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,737.32
|
| Rate for Payer: Health Management Network Commercial |
$2,894.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,205.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,205.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,205.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,050.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,838.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,050.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,838.12
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,210.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,294.19
|
| Rate for Payer: AlohaCare Medicare |
$1,193.56
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Devoted Health Medicare |
$1,312.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,193.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$1,878.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,432.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,432.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,432.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,294.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,193.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,294.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,193.56
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$692.12 |
| Max. Negotiated Rate |
$1,408.25 |
| Rate for Payer: AlohaCare Medicaid |
$914.81
|
| Rate for Payer: AlohaCare Medicare |
$828.08
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Devoted Health Medicare |
$910.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$828.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$692.12
|
| Rate for Payer: Health Management Network Commercial |
$1,323.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$993.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$993.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$993.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$914.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$828.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$914.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$828.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,408.25
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: AlohaCare Medicaid |
$98.96
|
| Rate for Payer: AlohaCare Medicare |
$83.98
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$92.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.98
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.98
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: AlohaCare Medicaid |
$102.20
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.20
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 92587 TC
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$43.71 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$3.99
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Devoted Health Medicare |
$4.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.99
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$43.71 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$23.09
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$25.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.09
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92587 26
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$43.71 |
| Rate for Payer: AlohaCare Medicaid |
$22.35
|
| Rate for Payer: AlohaCare Medicare |
$19.10
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$21.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.10
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92588 26
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$68.95 |
| Rate for Payer: AlohaCare Medicaid |
$34.75
|
| Rate for Payer: AlohaCare Medicare |
$29.96
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$32.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.95
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.96
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 92588 TC
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$68.95 |
| Rate for Payer: AlohaCare Medicaid |
$34.75
|
| Rate for Payer: AlohaCare Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$6.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.95
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.51
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$68.95 |
| Rate for Payer: AlohaCare Medicaid |
$34.75
|
| Rate for Payer: AlohaCare Medicare |
$35.47
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$39.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.95
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.47
|
|
