|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 35860
|
| Min. Negotiated Rate |
$339.04 |
| Max. Negotiated Rate |
$1,166.20 |
| Rate for Payer: AlohaCare Medicaid |
$800.08
|
| Rate for Payer: AlohaCare Medicare |
$745.00
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Devoted Health Medicare |
$819.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$745.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$339.04
|
| Rate for Payer: Health Management Network Commercial |
$1,166.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$894.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$894.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$894.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$800.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$745.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$800.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$745.00
|
|
|
PR EXPL RETROPERITONEUM W/WO BX SPX
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 49010
|
| Min. Negotiated Rate |
$741.26 |
| Max. Negotiated Rate |
$1,318.35 |
| Rate for Payer: AlohaCare Medicaid |
$902.96
|
| Rate for Payer: AlohaCare Medicare |
$838.87
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Devoted Health Medicare |
$922.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$838.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.26
|
| Rate for Payer: Health Management Network Commercial |
$1,318.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,006.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,006.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,006.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$902.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$838.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$902.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$838.87
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJURY
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 45562
|
| Min. Negotiated Rate |
$593.06 |
| Max. Negotiated Rate |
$1,697.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,163.64
|
| Rate for Payer: AlohaCare Medicare |
$1,109.53
|
| Rate for Payer: Cash Price |
$1,198.20
|
| Rate for Payer: Cash Price |
$1,198.20
|
| Rate for Payer: Devoted Health Medicare |
$1,220.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,109.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.06
|
| Rate for Payer: Health Management Network Commercial |
$1,697.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,331.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,331.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,331.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,163.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,109.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,163.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,109.53
|
|
|
PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 25248
|
| Min. Negotiated Rate |
$256.36 |
| Max. Negotiated Rate |
$644.30 |
| Rate for Payer: AlohaCare Medicaid |
$449.33
|
| Rate for Payer: AlohaCare Medicare |
$419.50
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Devoted Health Medicare |
$461.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$419.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$256.36
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$503.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$503.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$449.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$419.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$419.50
|
|
|
PR EXTERNAL ECG REC>48HR<7D RECORDING
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 93242
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: AlohaCare Medicaid |
$13.57
|
| Rate for Payer: AlohaCare Medicare |
$13.11
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.39
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.11
|
|
|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$40.62
|
|
|
Service Code
|
HCPCS 93244
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: AlohaCare Medicaid |
$23.14
|
| Rate for Payer: AlohaCare Medicare |
$23.21
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Devoted Health Medicare |
$25.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.66
|
| Rate for Payer: Health Management Network Commercial |
$34.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.21
|
|
|
PR EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 93243
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$413.95 |
| Rate for Payer: AlohaCare Medicaid |
$256.44
|
| Rate for Payer: AlohaCare Medicare |
$278.18
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Devoted Health Medicare |
$306.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.18
|
|
|
PR EXTERNAL ECG REC>7D<15D RECORDING
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 93246
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: AlohaCare Medicaid |
$13.57
|
| Rate for Payer: AlohaCare Medicare |
$13.11
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.39
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.11
|
|
|
PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$44.20
|
|
|
Service Code
|
HCPCS 93248
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: AlohaCare Medicaid |
$25.57
|
| Rate for Payer: AlohaCare Medicare |
$25.26
|
| Rate for Payer: Cash Price |
$26.52
|
| Rate for Payer: Cash Price |
$26.52
|
| Rate for Payer: Devoted Health Medicare |
$27.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.22
|
| Rate for Payer: Health Management Network Commercial |
$37.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.26
|
|
|
PR EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT R&I
|
Professional
|
Both
|
$571.24
|
|
|
Service Code
|
HCPCS 93245
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: AlohaCare Medicaid |
$308.20
|
| Rate for Payer: AlohaCare Medicare |
$326.04
|
| Rate for Payer: Cash Price |
$342.74
|
| Rate for Payer: Cash Price |
$342.74
|
| Rate for Payer: Devoted Health Medicare |
$358.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.22
|
| Rate for Payer: Health Management Network Commercial |
$485.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$391.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$308.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.04
|
|
|
PR EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT
|
Professional
|
Both
|
$504.10
|
|
|
Service Code
|
HCPCS 93247
|
| Min. Negotiated Rate |
$43.66 |
| Max. Negotiated Rate |
$428.49 |
| Rate for Payer: AlohaCare Medicaid |
$269.07
|
| Rate for Payer: AlohaCare Medicare |
$287.68
|
| Rate for Payer: Cash Price |
$302.46
|
| Rate for Payer: Cash Price |
$302.46
|
| Rate for Payer: Devoted Health Medicare |
$316.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.66
|
| Rate for Payer: Health Management Network Commercial |
$428.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.68
|
|
|
PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 26111
|
| Min. Negotiated Rate |
$308.10 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: AlohaCare Medicaid |
$438.69
|
| Rate for Payer: AlohaCare Medicare |
$403.44
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Devoted Health Medicare |
$443.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$403.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.10
|
| Rate for Payer: Health Management Network Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$484.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$438.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$438.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.44
|
|
|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 26113
|
| Min. Negotiated Rate |
$525.97 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: AlohaCare Medicaid |
$577.52
|
| Rate for Payer: AlohaCare Medicare |
$525.97
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Devoted Health Medicare |
$578.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$527.80
|
| Rate for Payer: Health Management Network Commercial |
$845.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$631.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$631.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$631.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$577.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$577.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.97
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$187.76
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: AlohaCare Medicaid |
$97.86
|
| Rate for Payer: AlohaCare Medicare |
$99.69
|
| Rate for Payer: Cash Price |
$112.66
|
| Rate for Payer: Cash Price |
$112.66
|
| Rate for Payer: Devoted Health Medicare |
$109.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.86
|
| Rate for Payer: Health Management Network Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$97.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.69
|
| Rate for Payer: University Health Alliance Commercial |
$113.90
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$194.42
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$165.26 |
| Rate for Payer: AlohaCare Medicaid |
$102.29
|
| Rate for Payer: AlohaCare Medicare |
$103.51
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Devoted Health Medicare |
$113.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.29
|
| Rate for Payer: Health Management Network Commercial |
$165.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.51
|
| Rate for Payer: University Health Alliance Commercial |
$124.35
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$1,204.54
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$323.96 |
| Max. Negotiated Rate |
$1,023.86 |
| Rate for Payer: AlohaCare Medicaid |
$512.82
|
| Rate for Payer: AlohaCare Medicare |
$476.02
|
| Rate for Payer: Cash Price |
$722.72
|
| Rate for Payer: Cash Price |
$722.72
|
| Rate for Payer: Devoted Health Medicare |
$523.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$512.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$775.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$512.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.96
|
| Rate for Payer: Health Management Network Commercial |
$1,023.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$512.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.02
|
| Rate for Payer: University Health Alliance Commercial |
$656.70
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: AlohaCare Medicaid |
$510.37
|
| Rate for Payer: AlohaCare Medicare |
$476.99
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Devoted Health Medicare |
$524.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$745.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$572.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$572.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$510.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$510.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.99
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$323.93 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: AlohaCare Medicaid |
$343.61
|
| Rate for Payer: AlohaCare Medicare |
$323.93
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Devoted Health Medicare |
$356.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$323.93
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$388.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$388.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$388.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$343.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$323.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$343.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$323.93
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$577.43 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$633.77
|
| Rate for Payer: AlohaCare Medicare |
$577.43
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Devoted Health Medicare |
$635.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$577.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$687.70
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$692.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$692.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$692.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$633.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$577.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$633.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$577.43
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$781.04 |
| Max. Negotiated Rate |
$1,292.00 |
| Rate for Payer: AlohaCare Medicaid |
$882.75
|
| Rate for Payer: AlohaCare Medicare |
$802.08
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Devoted Health Medicare |
$882.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$802.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$781.04
|
| Rate for Payer: Health Management Network Commercial |
$1,292.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$962.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$962.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$962.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$882.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$802.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$882.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$802.08
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: AlohaCare Medicaid |
$266.13
|
| Rate for Payer: AlohaCare Medicare |
$222.81
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Devoted Health Medicare |
$245.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.26
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$266.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.81
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 59025 26
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$51.24 |
| Rate for Payer: AlohaCare Medicaid |
$51.24
|
| Rate for Payer: AlohaCare Medicare |
$28.62
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$31.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.98
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.62
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: AlohaCare Medicaid |
$51.24
|
| Rate for Payer: AlohaCare Medicare |
$52.36
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Devoted Health Medicare |
$57.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.98
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.36
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: AlohaCare Medicaid |
$51.24
|
| Rate for Payer: AlohaCare Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Devoted Health Medicare |
$26.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.98
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.74
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$796.32
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$676.87 |
| Rate for Payer: AlohaCare Medicaid |
$106.88
|
| Rate for Payer: AlohaCare Medicare |
$91.60
|
| Rate for Payer: Cash Price |
$477.79
|
| Rate for Payer: Cash Price |
$477.79
|
| Rate for Payer: Devoted Health Medicare |
$100.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$530.92
|
| Rate for Payer: Health Management Network Commercial |
$676.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.60
|
| Rate for Payer: University Health Alliance Commercial |
$115.70
|
|
