|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: AlohaCare Medicaid |
$142.21
|
| Rate for Payer: AlohaCare Medicare |
$127.60
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$140.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.46
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.60
|
|
|
PR EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 43210
|
| Min. Negotiated Rate |
$376.32 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: AlohaCare Medicaid |
$422.43
|
| Rate for Payer: AlohaCare Medicare |
$376.32
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Devoted Health Medicare |
$413.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.32
|
| Rate for Payer: Health Management Network Commercial |
$614.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.32
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$177.04 |
| Max. Negotiated Rate |
$330.72 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicare |
$177.04
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Devoted Health Medicare |
$194.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.72
|
| Rate for Payer: Health Management Network Commercial |
$287.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$212.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.04
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,046.83
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$173.98 |
| Max. Negotiated Rate |
$889.81 |
| Rate for Payer: AlohaCare Medicaid |
$195.64
|
| Rate for Payer: AlohaCare Medicare |
$173.98
|
| Rate for Payer: Cash Price |
$628.10
|
| Rate for Payer: Cash Price |
$628.10
|
| Rate for Payer: Devoted Health Medicare |
$191.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$335.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$215.54
|
| Rate for Payer: Health Management Network Commercial |
$889.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.98
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$805.94
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$685.05 |
| Rate for Payer: AlohaCare Medicaid |
$139.09
|
| Rate for Payer: AlohaCare Medicare |
$124.82
|
| Rate for Payer: Cash Price |
$483.56
|
| Rate for Payer: Cash Price |
$483.56
|
| Rate for Payer: Devoted Health Medicare |
$137.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$262.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$256.36
|
| Rate for Payer: Health Management Network Commercial |
$685.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.82
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,331.21
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$178.13 |
| Max. Negotiated Rate |
$1,131.53 |
| Rate for Payer: AlohaCare Medicaid |
$199.98
|
| Rate for Payer: AlohaCare Medicare |
$178.13
|
| Rate for Payer: Cash Price |
$798.73
|
| Rate for Payer: Cash Price |
$798.73
|
| Rate for Payer: Devoted Health Medicare |
$195.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$431.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.02
|
| Rate for Payer: Health Management Network Commercial |
$1,131.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$213.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.13
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$237.64 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: AlohaCare Medicaid |
$268.76
|
| Rate for Payer: AlohaCare Medicare |
$237.64
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Devoted Health Medicare |
$261.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$296.40
|
| Rate for Payer: Health Management Network Commercial |
$390.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$268.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$268.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$28.56
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: AlohaCare Medicare |
$16.32
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Devoted Health Medicare |
$17.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.32
|
| Rate for Payer: Health Management Network Commercial |
$24.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.32
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$90.81
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$77.19 |
| Rate for Payer: AlohaCare Medicaid |
$51.75
|
| Rate for Payer: AlohaCare Medicare |
$42.39
|
| Rate for Payer: Cash Price |
$54.49
|
| Rate for Payer: Cash Price |
$54.49
|
| Rate for Payer: Devoted Health Medicare |
$46.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.75
|
| Rate for Payer: Health Management Network Commercial |
$77.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.39
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$68.13
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: AlohaCare Medicaid |
$38.99
|
| Rate for Payer: AlohaCare Medicare |
$31.71
|
| Rate for Payer: Cash Price |
$40.88
|
| Rate for Payer: Cash Price |
$40.88
|
| Rate for Payer: Devoted Health Medicare |
$34.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.99
|
| Rate for Payer: Health Management Network Commercial |
$57.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.71
|
|
|
PR ELECTROCONVULSIVE THERAPY
|
Professional
|
Both
|
$339.26
|
|
|
Service Code
|
HCPCS 90870
|
| Min. Negotiated Rate |
$98.91 |
| Max. Negotiated Rate |
$288.37 |
| Rate for Payer: AlohaCare Medicaid |
$104.97
|
| Rate for Payer: AlohaCare Medicare |
$98.91
|
| Rate for Payer: Cash Price |
$203.56
|
| Rate for Payer: Cash Price |
$203.56
|
| Rate for Payer: Devoted Health Medicare |
$108.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$104.97
|
| Rate for Payer: Health Management Network Commercial |
$288.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.91
|
| Rate for Payer: University Health Alliance Commercial |
$127.21
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$5,270.00
|
|
|
Service Code
|
HCPCS 95829 TC
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$4,479.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,990.80
|
| Rate for Payer: AlohaCare Medicare |
$1,858.43
|
| Rate for Payer: Cash Price |
$3,162.00
|
| Rate for Payer: Cash Price |
$3,162.00
|
| Rate for Payer: Devoted Health Medicare |
$2,044.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,858.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.25
|
| Rate for Payer: Health Management Network Commercial |
$4,479.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,230.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,230.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,230.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,990.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,858.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,990.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,858.43
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$5,882.00
|
|
|
Service Code
|
HCPCS 95829
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$4,999.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,990.80
|
| Rate for Payer: AlohaCare Medicare |
$2,208.16
|
| Rate for Payer: Cash Price |
$3,529.20
|
| Rate for Payer: Cash Price |
$3,529.20
|
| Rate for Payer: Devoted Health Medicare |
$2,428.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,208.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.25
|
| Rate for Payer: Health Management Network Commercial |
$4,999.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,649.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,649.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,649.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,990.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,208.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,990.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,208.16
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 95829 26
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,990.80
|
| Rate for Payer: AlohaCare Medicare |
$349.73
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Devoted Health Medicare |
$384.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.25
|
| Rate for Payer: Health Management Network Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$419.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$419.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,990.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,990.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.73
|
|
|
PR ELECTRODIAG STUDIES DSP DOCD RVWD W/IN 6 MONTHS
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 3751F
|
| Min. Negotiated Rate |
$674.90 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Health Management Network Commercial |
$674.90
|
|
|
PR ELECTRODIAG STUDIES DSP NOT DOCD RVWD W/IN 6 MON
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 3752F
|
| Min. Negotiated Rate |
$1,064.20 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 95812 26
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$395.24 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$60.59
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$66.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.59
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$428.97
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Devoted Health Medicare |
$471.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$428.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$1,014.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$514.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$514.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$428.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$428.97
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 95812 TC
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: AlohaCare Medicaid |
$395.24
|
| Rate for Payer: AlohaCare Medicare |
$368.39
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Devoted Health Medicare |
$405.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.70
|
| Rate for Payer: Health Management Network Commercial |
$923.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$442.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.39
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$1,148.35 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$442.64
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Devoted Health Medicare |
$486.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$1,148.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.64
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$1,235.90 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$501.46
|
| Rate for Payer: Cash Price |
$872.40
|
| Rate for Payer: Cash Price |
$872.40
|
| Rate for Payer: Devoted Health Medicare |
$551.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$501.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$1,235.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$501.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$501.46
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95822 26
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$466.95 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$58.82
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$64.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.56
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.82
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95819 26
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$514.57 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$58.82
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$64.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.82
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 95819 TC
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$1,257.15 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$482.71
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Devoted Health Medicare |
$530.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$1,257.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.71
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$1,344.70 |
| Rate for Payer: AlohaCare Medicaid |
$514.57
|
| Rate for Payer: AlohaCare Medicare |
$541.53
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Devoted Health Medicare |
$595.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$541.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.84
|
| Rate for Payer: Health Management Network Commercial |
$1,344.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$649.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$649.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$649.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$514.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$541.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$514.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$541.53
|
|
