|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 93304 26
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$35.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$39.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.78
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$170.61
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Devoted Health Medicare |
$187.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$423.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.61
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: AlohaCare Medicaid |
$173.53
|
| Rate for Payer: AlohaCare Medicare |
$134.82
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Devoted Health Medicare |
$148.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.03
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.82
|
|
|
PR FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 26820
|
| Min. Negotiated Rate |
$496.34 |
| Max. Negotiated Rate |
$1,282.65 |
| Rate for Payer: AlohaCare Medicaid |
$889.21
|
| Rate for Payer: AlohaCare Medicare |
$855.17
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Devoted Health Medicare |
$940.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$855.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$496.34
|
| Rate for Payer: Health Management Network Commercial |
$1,282.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,026.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,026.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,026.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$889.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$855.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$889.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$855.17
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$55.07
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$60.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.07
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727 TC
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$42.73
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Devoted Health Medicare |
$47.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.73
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 94727 26
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: AlohaCare Medicaid |
$49.57
|
| Rate for Payer: AlohaCare Medicare |
$12.34
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.02
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.34
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 91034 TC
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$172.42
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Devoted Health Medicare |
$189.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$435.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.42
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$512.55 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$224.30
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Devoted Health Medicare |
$246.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.30
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 91034 26
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$238.29 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$51.88
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$57.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.88
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 91037 26
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$53.21
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$58.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.21
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.21
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$207.40
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$228.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.40
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.40
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 91037 TC
|
| Min. Negotiated Rate |
$154.19 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$154.19
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$169.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.19
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.19
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$475.05 |
| Max. Negotiated Rate |
$1,256.30 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$561.28
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Devoted Health Medicare |
$617.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$561.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$1,256.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$673.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$673.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$673.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$561.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$561.28
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 91035 26
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$511.07 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$87.33
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$96.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.33
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 91035 TC
|
| Min. Negotiated Rate |
$473.96 |
| Max. Negotiated Rate |
$1,126.25 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$473.96
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Devoted Health Medicare |
$521.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$473.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$1,126.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$568.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$473.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$473.96
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$1,926.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,323.27
|
| Rate for Payer: AlohaCare Medicare |
$1,224.90
|
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Devoted Health Medicare |
$1,347.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,224.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$1,926.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,469.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,469.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,469.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,323.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,224.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,323.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,224.90
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$1,946.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,336.28
|
| Rate for Payer: AlohaCare Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Devoted Health Medicare |
$1,362.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,238.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$537.94
|
| Rate for Payer: Health Management Network Commercial |
$1,946.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,485.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,485.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,336.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,238.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,336.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,238.26
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$521.56 |
| Max. Negotiated Rate |
$1,024.25 |
| Rate for Payer: AlohaCare Medicaid |
$704.39
|
| Rate for Payer: AlohaCare Medicare |
$670.29
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Devoted Health Medicare |
$737.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$670.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$521.56
|
| Rate for Payer: Health Management Network Commercial |
$1,024.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$804.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$804.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$704.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$670.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$704.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$670.29
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,339.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$427.44 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: AlohaCare Medicaid |
$779.82
|
| Rate for Payer: AlohaCare Medicare |
$737.22
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Devoted Health Medicare |
$810.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$737.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.44
|
| Rate for Payer: Health Management Network Commercial |
$1,138.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$884.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$779.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$737.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$779.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$737.22
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$700.44 |
| Max. Negotiated Rate |
$1,925.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.81
|
| Rate for Payer: AlohaCare Medicare |
$1,232.85
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Devoted Health Medicare |
$1,356.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,232.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$700.44
|
| Rate for Payer: Health Management Network Commercial |
$1,925.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,479.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,479.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,479.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,232.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,232.85
|
|
|
PR GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
HCPCS 43361
|
| Min. Negotiated Rate |
$1,695.98 |
| Max. Negotiated Rate |
$3,832.65 |
| Rate for Payer: AlohaCare Medicaid |
$2,631.14
|
| Rate for Payer: AlohaCare Medicare |
$2,424.95
|
| Rate for Payer: Cash Price |
$2,705.40
|
| Rate for Payer: Cash Price |
$2,705.40
|
| Rate for Payer: Devoted Health Medicare |
$2,667.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,424.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,695.98
|
| Rate for Payer: Health Management Network Commercial |
$3,832.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,909.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,909.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,909.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,631.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,424.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,631.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,424.95
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 91110 26
|
| Min. Negotiated Rate |
$122.59 |
| Max. Negotiated Rate |
$986.15 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$122.59
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Devoted Health Medicare |
$134.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.59
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 91110 TC
|
| Min. Negotiated Rate |
$777.96 |
| Max. Negotiated Rate |
$1,853.85 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$777.96
|
| Rate for Payer: Cash Price |
$1,308.60
|
| Rate for Payer: Cash Price |
$1,308.60
|
| Rate for Payer: Devoted Health Medicare |
$855.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$777.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$1,853.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$933.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$933.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$933.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$777.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$777.96
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$824.94 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$900.55
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Devoted Health Medicare |
$990.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$900.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$2,036.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,080.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,080.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,080.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$900.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$900.55
|
|
