|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$513.85
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$436.77 |
| Rate for Payer: AlohaCare Medicaid |
$189.71
|
| Rate for Payer: AlohaCare Medicare |
$175.90
|
| Rate for Payer: Cash Price |
$308.31
|
| Rate for Payer: Cash Price |
$308.31
|
| Rate for Payer: Devoted Health Medicare |
$193.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.06
|
| Rate for Payer: Health Management Network Commercial |
$436.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.90
|
| Rate for Payer: University Health Alliance Commercial |
$216.52
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$298.94
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: AlohaCare Medicaid |
$113.02
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Devoted Health Medicare |
$118.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$254.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.15
|
| Rate for Payer: University Health Alliance Commercial |
$125.09
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$428.84
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$364.51 |
| Rate for Payer: AlohaCare Medicaid |
$114.89
|
| Rate for Payer: AlohaCare Medicare |
$110.61
|
| Rate for Payer: Cash Price |
$257.30
|
| Rate for Payer: Cash Price |
$257.30
|
| Rate for Payer: Devoted Health Medicare |
$121.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$174.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$364.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.61
|
| Rate for Payer: University Health Alliance Commercial |
$175.00
|
|
|
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 90875
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.23
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
|
|
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 90876
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.79
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: AlohaCare Medicaid |
$423.51
|
| Rate for Payer: AlohaCare Medicare |
$372.48
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Devoted Health Medicare |
$409.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.98
|
| Rate for Payer: Health Management Network Commercial |
$610.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$446.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$446.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$423.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$423.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.48
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$741.51
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$630.28 |
| Rate for Payer: AlohaCare Medicaid |
$370.89
|
| Rate for Payer: AlohaCare Medicare |
$324.41
|
| Rate for Payer: Cash Price |
$444.91
|
| Rate for Payer: Cash Price |
$444.91
|
| Rate for Payer: Devoted Health Medicare |
$356.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$370.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$360.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$370.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.52
|
| Rate for Payer: Health Management Network Commercial |
$630.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$389.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$389.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.41
|
| Rate for Payer: University Health Alliance Commercial |
$491.55
|
|
|
PR INDWELLING CATHETER LATEX
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A4338
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$8.32
|
| Rate for Payer: AlohaCare Medicare |
$18.88
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.88
|
|
|
PR INFLUENZA VIRUS VACCINE, NOS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS Q2039
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$47.57 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$295.67 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: AlohaCare Medicaid |
$339.70
|
| Rate for Payer: AlohaCare Medicare |
$295.67
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Devoted Health Medicare |
$325.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.05
|
| Rate for Payer: Health Management Network Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.67
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$348.60
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: AlohaCare Medicaid |
$185.44
|
| Rate for Payer: AlohaCare Medicare |
$165.40
|
| Rate for Payer: Cash Price |
$209.16
|
| Rate for Payer: Cash Price |
$209.16
|
| Rate for Payer: Devoted Health Medicare |
$181.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.07
|
| Rate for Payer: Health Management Network Commercial |
$296.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$185.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.40
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$254.57
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$76.02 |
| Max. Negotiated Rate |
$216.38 |
| Rate for Payer: AlohaCare Medicaid |
$136.11
|
| Rate for Payer: AlohaCare Medicare |
$121.54
|
| Rate for Payer: Cash Price |
$152.74
|
| Rate for Payer: Cash Price |
$152.74
|
| Rate for Payer: Devoted Health Medicare |
$133.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.02
|
| Rate for Payer: Health Management Network Commercial |
$216.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.54
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$146.54
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$124.56 |
| Rate for Payer: AlohaCare Medicaid |
$81.82
|
| Rate for Payer: AlohaCare Medicare |
$72.35
|
| Rate for Payer: Cash Price |
$87.92
|
| Rate for Payer: Cash Price |
$87.92
|
| Rate for Payer: Devoted Health Medicare |
$79.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.35
|
| Rate for Payer: Health Management Network Commercial |
$124.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.35
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$675.18 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: AlohaCare Medicaid |
$776.41
|
| Rate for Payer: AlohaCare Medicare |
$675.18
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Devoted Health Medicare |
$742.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$675.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$747.25
|
| Rate for Payer: Health Management Network Commercial |
$1,116.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$776.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$776.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$675.18
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$474.74 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$558.03
|
| Rate for Payer: AlohaCare Medicare |
$474.74
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$522.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$474.74
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$569.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$569.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$569.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$558.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$474.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$558.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$474.74
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$321.21
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: AlohaCare Medicare |
$114.81
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Devoted Health Medicare |
$126.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.94
|
| Rate for Payer: Health Management Network Commercial |
$273.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.81
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: AlohaCare Medicaid |
$73.80
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.80
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: AlohaCare Medicaid |
$114.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.60
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: AlohaCare Medicaid |
$123.12
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$121.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.17
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.12
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$75.41 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: AlohaCare Medicaid |
$98.65
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.41
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.65
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AlohaCare Medicaid |
$78.84
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$77.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$77.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.67
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.84
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: AlohaCare Medicaid |
$94.46
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$211.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.46
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$67.77 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: AlohaCare Medicaid |
$83.70
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.77
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.70
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$111.51
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$94.78 |
| Rate for Payer: AlohaCare Medicaid |
$38.69
|
| Rate for Payer: AlohaCare Medicare |
$32.96
|
| Rate for Payer: Cash Price |
$66.91
|
| Rate for Payer: Cash Price |
$66.91
|
| Rate for Payer: Devoted Health Medicare |
$36.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$94.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.96
|
| Rate for Payer: University Health Alliance Commercial |
$48.22
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$451.78
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$384.01 |
| Rate for Payer: AlohaCare Medicaid |
$83.43
|
| Rate for Payer: AlohaCare Medicare |
$73.97
|
| Rate for Payer: Cash Price |
$271.07
|
| Rate for Payer: Cash Price |
$271.07
|
| Rate for Payer: Devoted Health Medicare |
$81.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$129.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.46
|
| Rate for Payer: Health Management Network Commercial |
$384.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.97
|
| Rate for Payer: University Health Alliance Commercial |
$110.69
|
|
