|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 95816 26
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$445.92 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$58.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Devoted Health Medicare |
$64.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.44
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$1,141.55 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$463.48
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Devoted Health Medicare |
$509.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$463.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$1,141.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$556.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$556.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$556.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$463.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$463.48
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 95816 TC
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$1,054.85 |
| Rate for Payer: AlohaCare Medicaid |
$445.92
|
| Rate for Payer: AlohaCare Medicare |
$405.04
|
| Rate for Payer: Cash Price |
$744.60
|
| Rate for Payer: Cash Price |
$744.60
|
| Rate for Payer: Devoted Health Medicare |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.68
|
| Rate for Payer: Health Management Network Commercial |
$1,054.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$486.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.04
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$61,577.80
|
|
|
Service Code
|
MSDRG 791
|
| Min. Negotiated Rate |
$61,577.80 |
| Max. Negotiated Rate |
$61,577.80 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$61,577.80
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$12,325.04
|
|
|
Service Code
|
MSDRG 792
|
| Min. Negotiated Rate |
$12,325.04 |
| Max. Negotiated Rate |
$12,325.04 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,325.04
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$518.79 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: AlohaCare Medicaid |
$562.07
|
| Rate for Payer: AlohaCare Medicare |
$518.79
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$570.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$536.38
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$622.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$622.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$562.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$562.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.79
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,381.25 |
| Rate for Payer: AlohaCare Medicaid |
$953.59
|
| Rate for Payer: AlohaCare Medicare |
$877.13
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Devoted Health Medicare |
$964.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$877.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$1,381.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,052.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,052.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$953.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$877.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$953.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$877.13
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$613.08 |
| Max. Negotiated Rate |
$1,288.60 |
| Rate for Payer: AlohaCare Medicaid |
$888.56
|
| Rate for Payer: AlohaCare Medicare |
$818.14
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Devoted Health Medicare |
$899.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$818.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$613.08
|
| Rate for Payer: Health Management Network Commercial |
$1,288.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$981.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$981.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$981.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$888.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$818.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$888.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$818.14
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,216.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$846.82 |
| Max. Negotiated Rate |
$1,883.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.80
|
| Rate for Payer: AlohaCare Medicare |
$1,195.69
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Devoted Health Medicare |
$1,315.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,195.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$846.82
|
| Rate for Payer: Health Management Network Commercial |
$1,883.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,434.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,434.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,434.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,195.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,195.69
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$460.20 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: AlohaCare Medicaid |
$561.31
|
| Rate for Payer: AlohaCare Medicare |
$519.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Devoted Health Medicare |
$571.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$519.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$815.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$623.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$623.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$561.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$519.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$561.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$519.54
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$293.25
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$167.57 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: AlohaCare Medicaid |
$170.83
|
| Rate for Payer: AlohaCare Medicare |
$167.57
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Devoted Health Medicare |
$184.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.10
|
| Rate for Payer: Health Management Network Commercial |
$249.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.57
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$118.90
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$67.94 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: AlohaCare Medicaid |
$69.44
|
| Rate for Payer: AlohaCare Medicare |
$67.94
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Devoted Health Medicare |
$74.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.92
|
| Rate for Payer: Health Management Network Commercial |
$101.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.94
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$18.95
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: AlohaCare Medicaid |
$11.18
|
| Rate for Payer: AlohaCare Medicare |
$10.83
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Devoted Health Medicare |
$11.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.90
|
| Rate for Payer: Health Management Network Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.83
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$201.92
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$115.38 |
| Max. Negotiated Rate |
$171.63 |
| Rate for Payer: AlohaCare Medicaid |
$118.04
|
| Rate for Payer: AlohaCare Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Devoted Health Medicare |
$126.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.86
|
| Rate for Payer: Health Management Network Commercial |
$171.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.38
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$69.39
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$58.98 |
| Rate for Payer: AlohaCare Medicaid |
$40.86
|
| Rate for Payer: AlohaCare Medicare |
$39.65
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: Devoted Health Medicare |
$43.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.62
|
| Rate for Payer: Health Management Network Commercial |
$58.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.65
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$70.74
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$77.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.74
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 51784 26
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$37.51
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$41.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.51
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: AlohaCare Medicaid |
$68.53
|
| Rate for Payer: AlohaCare Medicare |
$33.23
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Devoted Health Medicare |
$36.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.23
|
|
|
PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT
|
Professional
|
Both
|
$709.45
|
|
|
Service Code
|
HCPCS 47543
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$1,536.86 |
| Rate for Payer: AlohaCare Medicaid |
$137.78
|
| Rate for Payer: AlohaCare Medicare |
$120.20
|
| Rate for Payer: Cash Price |
$425.67
|
| Rate for Payer: Cash Price |
$425.67
|
| Rate for Payer: Devoted Health Medicare |
$132.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,536.86
|
| Rate for Payer: Health Management Network Commercial |
$603.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.20
|
| Rate for Payer: University Health Alliance Commercial |
$184.79
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$126.19
|
|
|
Service Code
|
HCPCS 92979 26
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: AlohaCare Medicaid |
$138.64
|
| Rate for Payer: AlohaCare Medicare |
$72.11
|
| Rate for Payer: Cash Price |
$75.71
|
| Rate for Payer: Cash Price |
$75.71
|
| Rate for Payer: Devoted Health Medicare |
$79.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.22
|
| Rate for Payer: Health Management Network Commercial |
$107.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.11
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$158.92
|
|
|
Service Code
|
HCPCS 92978 26
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: AlohaCare Medicaid |
$229.41
|
| Rate for Payer: AlohaCare Medicare |
$90.81
|
| Rate for Payer: Cash Price |
$95.35
|
| Rate for Payer: Cash Price |
$95.35
|
| Rate for Payer: Devoted Health Medicare |
$99.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.06
|
| Rate for Payer: Health Management Network Commercial |
$135.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.81
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$91.10
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$77.44 |
| Rate for Payer: AlohaCare Medicaid |
$39.53
|
| Rate for Payer: AlohaCare Medicare |
$34.21
|
| Rate for Payer: Cash Price |
$54.66
|
| Rate for Payer: Cash Price |
$54.66
|
| Rate for Payer: Devoted Health Medicare |
$37.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$77.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.21
|
| Rate for Payer: University Health Alliance Commercial |
$49.26
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$179.10
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$53.35 |
| Max. Negotiated Rate |
$152.24 |
| Rate for Payer: AlohaCare Medicaid |
$62.37
|
| Rate for Payer: AlohaCare Medicare |
$53.35
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Devoted Health Medicare |
$58.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$152.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.35
|
| Rate for Payer: University Health Alliance Commercial |
$76.97
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$144.33
|
| Rate for Payer: AlohaCare Medicare |
$129.11
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$142.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.04
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$154.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.11
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: AlohaCare Medicaid |
$158.80
|
| Rate for Payer: AlohaCare Medicare |
$142.12
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Devoted Health Medicare |
$156.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.72
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.12
|
|
