|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$1,901.00
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$753.74 |
| Max. Negotiated Rate |
$1,615.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,108.49
|
| Rate for Payer: AlohaCare Medicare |
$1,040.86
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Devoted Health Medicare |
$1,144.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,040.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$753.74
|
| Rate for Payer: Health Management Network Commercial |
$1,615.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,249.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,249.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,249.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,108.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,040.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,108.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,040.86
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 47563
|
| Min. Negotiated Rate |
$672.19 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$714.60
|
| Rate for Payer: AlohaCare Medicare |
$672.19
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$739.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$672.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.92
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$806.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$806.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$806.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$714.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$672.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$714.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$672.19
|
|
|
PR LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 43280
|
| Min. Negotiated Rate |
$956.02 |
| Max. Negotiated Rate |
$1,539.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,057.32
|
| Rate for Payer: AlohaCare Medicare |
$984.20
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Devoted Health Medicare |
$1,082.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$984.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$956.02
|
| Rate for Payer: Health Management Network Commercial |
$1,539.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,181.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,181.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,181.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,057.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$984.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,057.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$984.20
|
|
|
PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 43653
|
| Min. Negotiated Rate |
$476.84 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: AlohaCare Medicaid |
$584.62
|
| Rate for Payer: AlohaCare Medicare |
$564.47
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Devoted Health Medicare |
$620.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$564.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$677.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$677.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$584.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$564.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$584.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$564.47
|
|
|
PR LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT
|
Professional
|
Both
|
$2,045.00
|
|
|
Service Code
|
HCPCS 55866
|
| Min. Negotiated Rate |
$1,077.11 |
| Max. Negotiated Rate |
$1,738.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,193.90
|
| Rate for Payer: AlohaCare Medicare |
$1,077.11
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Devoted Health Medicare |
$1,184.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,077.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,571.18
|
| Rate for Payer: Health Management Network Commercial |
$1,738.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,292.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,292.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,292.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,193.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,077.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,193.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,077.11
|
|
|
PR LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASSISTANCE
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 55867
|
| Min. Negotiated Rate |
$942.53 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,050.25
|
| Rate for Payer: AlohaCare Medicare |
$942.53
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Devoted Health Medicare |
$1,036.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$942.53
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,131.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,131.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,050.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$942.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,050.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$942.53
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 38570
|
| Min. Negotiated Rate |
$476.35 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: AlohaCare Medicaid |
$522.71
|
| Rate for Payer: AlohaCare Medicare |
$476.35
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Devoted Health Medicare |
$523.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.35
|
| Rate for Payer: Health Management Network Commercial |
$759.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$522.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$522.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.35
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 49651
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: AlohaCare Medicaid |
$571.54
|
| Rate for Payer: AlohaCare Medicare |
$548.02
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Devoted Health Medicare |
$602.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$509.60
|
| Rate for Payer: Health Management Network Commercial |
$833.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$657.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$657.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$571.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$571.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.02
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 43651
|
| Min. Negotiated Rate |
$626.57 |
| Max. Negotiated Rate |
$959.65 |
| Rate for Payer: AlohaCare Medicaid |
$658.26
|
| Rate for Payer: AlohaCare Medicare |
$626.57
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Devoted Health Medicare |
$689.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.57
|
| Rate for Payer: Health Management Network Commercial |
$959.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$751.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$751.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$751.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$658.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.57
|
|
|
PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49322
|
| Min. Negotiated Rate |
$350.79 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: AlohaCare Medicaid |
$375.18
|
| Rate for Payer: AlohaCare Medicare |
$350.79
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Devoted Health Medicare |
$385.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$350.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.64
|
| Rate for Payer: Health Management Network Commercial |
$545.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$420.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$420.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$420.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$350.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$350.79
|
|
|
PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 49323
|
| Min. Negotiated Rate |
$597.95 |
| Max. Negotiated Rate |
$933.30 |
| Rate for Payer: AlohaCare Medicaid |
$640.11
|
| Rate for Payer: AlohaCare Medicare |
$597.95
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Devoted Health Medicare |
$657.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$597.95
|
| Rate for Payer: Health Management Network Commercial |
$933.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$717.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$717.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$717.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$640.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$597.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$640.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$597.95
|
|
|
PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 58571
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$1,335.35 |
| Rate for Payer: AlohaCare Medicaid |
$925.01
|
| Rate for Payer: AlohaCare Medicare |
$819.91
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Devoted Health Medicare |
$901.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$819.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$990.86
|
| Rate for Payer: Health Management Network Commercial |
$1,335.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$983.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$983.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$925.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$819.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$925.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$819.91
|
|
|
PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 59151
|
| Min. Negotiated Rate |
$602.68 |
| Max. Negotiated Rate |
$1,103.30 |
| Rate for Payer: AlohaCare Medicaid |
$766.13
|
| Rate for Payer: AlohaCare Medicare |
$665.05
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Devoted Health Medicare |
$731.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$665.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$602.68
|
| Rate for Payer: Health Management Network Commercial |
$1,103.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$798.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$766.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$665.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$766.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$665.05
|
|
|
PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,363.00
|
|
|
Service Code
|
HCPCS 50947
|
| Min. Negotiated Rate |
$1,225.95 |
| Max. Negotiated Rate |
$2,008.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,381.47
|
| Rate for Payer: AlohaCare Medicare |
$1,225.95
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Devoted Health Medicare |
$1,348.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,225.95
|
| Rate for Payer: Health Management Network Commercial |
$2,008.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,471.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,471.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,471.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,381.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,225.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,381.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,225.95
|
|
|
PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 58554
|
| Min. Negotiated Rate |
$1,037.40 |
| Max. Negotiated Rate |
$1,892.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,310.83
|
| Rate for Payer: AlohaCare Medicare |
$1,140.95
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Devoted Health Medicare |
$1,255.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,140.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,037.40
|
| Rate for Payer: Health Management Network Commercial |
$1,892.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,369.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,369.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,369.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,310.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,140.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,310.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,140.95
|
|
|
PR LAPS W/REVISION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 49325
|
| Min. Negotiated Rate |
$379.38 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: AlohaCare Medicaid |
$406.78
|
| Rate for Payer: AlohaCare Medicare |
$379.38
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Devoted Health Medicare |
$417.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.06
|
| Rate for Payer: Health Management Network Commercial |
$590.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$455.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$455.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$406.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.38
|
|
|
PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 58552
|
| Min. Negotiated Rate |
$765.70 |
| Max. Negotiated Rate |
$1,433.95 |
| Rate for Payer: Ohana Health Plan Medicare |
$865.91
|
| Rate for Payer: AlohaCare Medicaid |
$990.56
|
| Rate for Payer: AlohaCare Medicare |
$865.91
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Devoted Health Medicare |
$952.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$865.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$765.70
|
| Rate for Payer: Health Management Network Commercial |
$1,433.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,039.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,039.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,039.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$990.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$990.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$865.91
|
|
|
PR LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 31541
|
| Min. Negotiated Rate |
$221.96 |
| Max. Negotiated Rate |
$383.35 |
| Rate for Payer: AlohaCare Medicaid |
$264.14
|
| Rate for Payer: AlohaCare Medicare |
$221.96
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Devoted Health Medicare |
$244.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$351.78
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.96
|
|
|
PR LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 31571
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$363.80 |
| Rate for Payer: AlohaCare Medicaid |
$250.15
|
| Rate for Payer: AlohaCare Medicare |
$210.22
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Devoted Health Medicare |
$231.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$210.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$250.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$250.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.22
|
|
|
PR LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 31535
|
| Min. Negotiated Rate |
$161.71 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: AlohaCare Medicaid |
$191.04
|
| Rate for Payer: AlohaCare Medicare |
$161.71
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Devoted Health Medicare |
$177.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.72
|
| Rate for Payer: Health Management Network Commercial |
$277.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.71
|
|
|
PR LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 31540
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: AlohaCare Medicaid |
$242.44
|
| Rate for Payer: AlohaCare Medicare |
$204.35
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Devoted Health Medicare |
$224.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$252.46
|
| Rate for Payer: Health Management Network Commercial |
$352.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.35
|
|
|
PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC
|
Professional
|
Both
|
$241.60
|
|
|
Service Code
|
HCPCS 31575
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: AlohaCare Medicaid |
$71.39
|
| Rate for Payer: AlohaCare Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$144.96
|
| Rate for Payer: Cash Price |
$144.96
|
| Rate for Payer: Devoted Health Medicare |
$69.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.98
|
| Rate for Payer: Health Management Network Commercial |
$205.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.86
|
| Rate for Payer: University Health Alliance Commercial |
$89.27
|
|
|
PR LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES)
|
Professional
|
Both
|
$511.12
|
|
|
Service Code
|
HCPCS 31576
|
| Min. Negotiated Rate |
$104.84 |
| Max. Negotiated Rate |
$434.45 |
| Rate for Payer: AlohaCare Medicaid |
$122.27
|
| Rate for Payer: AlohaCare Medicare |
$104.84
|
| Rate for Payer: Cash Price |
$306.67
|
| Rate for Payer: Cash Price |
$306.67
|
| Rate for Payer: Devoted Health Medicare |
$115.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$186.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$434.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.84
|
| Rate for Payer: University Health Alliance Commercial |
$158.13
|
|
|
PR LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31574
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$1,499.40 |
| Rate for Payer: AlohaCare Medicaid |
$151.87
|
| Rate for Payer: AlohaCare Medicare |
$129.42
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Devoted Health Medicare |
$142.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$233.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.87
|
| Rate for Payer: Health Management Network Commercial |
$1,499.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.42
|
| Rate for Payer: University Health Alliance Commercial |
$197.32
|
|
|
PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)
|
Professional
|
Both
|
$527.38
|
|
|
Service Code
|
HCPCS 31577
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$448.27 |
| Rate for Payer: AlohaCare Medicaid |
$135.29
|
| Rate for Payer: AlohaCare Medicare |
$119.07
|
| Rate for Payer: Cash Price |
$316.43
|
| Rate for Payer: Cash Price |
$316.43
|
| Rate for Payer: Devoted Health Medicare |
$130.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.96
|
| Rate for Payer: Health Management Network Commercial |
$448.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$142.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.07
|
| Rate for Payer: University Health Alliance Commercial |
$180.25
|
|
