|
PR HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90634
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$81.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.21
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.73
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$75.15
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Devoted Health Medicare |
$82.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.48
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.15
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$75.15
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$82.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.64
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.15
|
|
|
PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 90747
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$164.42
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$180.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$197.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.42
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$33.20
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$36.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.77
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.20
|
|
|
PR HFO WITHOUT JOINTS PRE OTS
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS L3924
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$92.52
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$101.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.25
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.52
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.04
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.55
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$347.48
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$295.36 |
| Rate for Payer: AlohaCare Medicaid |
$188.57
|
| Rate for Payer: AlohaCare Medicare |
$198.56
|
| Rate for Payer: Cash Price |
$208.49
|
| Rate for Payer: Cash Price |
$208.49
|
| Rate for Payer: Devoted Health Medicare |
$218.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.08
|
| Rate for Payer: Health Management Network Commercial |
$295.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.56
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$142.56
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: AlohaCare Medicaid |
$78.20
|
| Rate for Payer: AlohaCare Medicare |
$81.46
|
| Rate for Payer: Cash Price |
$85.54
|
| Rate for Payer: Cash Price |
$85.54
|
| Rate for Payer: Devoted Health Medicare |
$89.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.38
|
| Rate for Payer: Health Management Network Commercial |
$121.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.46
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$238.42
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$96.63 |
| Max. Negotiated Rate |
$202.66 |
| Rate for Payer: AlohaCare Medicaid |
$129.72
|
| Rate for Payer: AlohaCare Medicare |
$136.24
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Devoted Health Medicare |
$149.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.63
|
| Rate for Payer: Health Management Network Commercial |
$202.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.24
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$83.20
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$70.72 |
| Rate for Payer: AlohaCare Medicaid |
$46.19
|
| Rate for Payer: AlohaCare Medicare |
$47.54
|
| Rate for Payer: Cash Price |
$49.92
|
| Rate for Payer: Cash Price |
$49.92
|
| Rate for Payer: Devoted Health Medicare |
$52.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.79
|
| Rate for Payer: Health Management Network Commercial |
$70.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.54
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$378.80
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$205.73 |
| Max. Negotiated Rate |
$321.98 |
| Rate for Payer: AlohaCare Medicaid |
$205.73
|
| Rate for Payer: AlohaCare Medicare |
$216.46
|
| Rate for Payer: Cash Price |
$227.28
|
| Rate for Payer: Cash Price |
$227.28
|
| Rate for Payer: Devoted Health Medicare |
$238.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$220.97
|
| Rate for Payer: Health Management Network Commercial |
$321.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$259.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.46
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$141.35
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$78.09 |
| Max. Negotiated Rate |
$120.15 |
| Rate for Payer: AlohaCare Medicaid |
$79.37
|
| Rate for Payer: AlohaCare Medicare |
$80.77
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Devoted Health Medicare |
$88.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.09
|
| Rate for Payer: Health Management Network Commercial |
$120.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.77
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$263.55
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$224.02 |
| Rate for Payer: AlohaCare Medicaid |
$144.42
|
| Rate for Payer: AlohaCare Medicare |
$150.60
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Devoted Health Medicare |
$165.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.23
|
| Rate for Payer: Health Management Network Commercial |
$224.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.60
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$88.38
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$75.12 |
| Rate for Payer: AlohaCare Medicaid |
$50.29
|
| Rate for Payer: AlohaCare Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Devoted Health Medicare |
$55.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.66
|
| Rate for Payer: Health Management Network Commercial |
$75.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.50
|
|
|
PR HOME VISIT WOUND CARE
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS S9097
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 99236
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: AlohaCare Medicaid |
$208.78
|
| Rate for Payer: AlohaCare Medicare |
$189.32
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Devoted Health Medicare |
$208.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$164.50
|
| Rate for Payer: Health Management Network Commercial |
$300.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.32
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 99235
|
| Min. Negotiated Rate |
$117.50 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: AlohaCare Medicaid |
$160.14
|
| Rate for Payer: AlohaCare Medicare |
$143.06
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Devoted Health Medicare |
$157.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.50
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.06
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 99234
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$97.67
|
| Rate for Payer: AlohaCare Medicare |
$87.75
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$96.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.50
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$97.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.75
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: AlohaCare Medicaid |
$116.44
|
| Rate for Payer: AlohaCare Medicare |
$108.33
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Devoted Health Medicare |
$119.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.33
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.33
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: AlohaCare Medicaid |
$82.58
|
| Rate for Payer: AlohaCare Medicare |
$75.97
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$83.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.97
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$524.50 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: AlohaCare Medicaid |
$549.49
|
| Rate for Payer: AlohaCare Medicare |
$524.50
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Devoted Health Medicare |
$576.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$524.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$569.40
|
| Rate for Payer: Health Management Network Commercial |
$799.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$629.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$629.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$524.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$524.50
|
|
|
PR HYPNOTHERAPY
|
Professional
|
Both
|
$188.49
|
|
|
Service Code
|
HCPCS 90880
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$160.22 |
| Rate for Payer: AlohaCare Medicaid |
$86.26
|
| Rate for Payer: AlohaCare Medicare |
$79.99
|
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Devoted Health Medicare |
$87.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.26
|
| Rate for Payer: Health Management Network Commercial |
$160.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.99
|
| Rate for Payer: University Health Alliance Commercial |
$106.84
|
|
