|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: AlohaCare Medicaid |
$2.36
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.17
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.36
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: AlohaCare Medicaid |
$205.42
|
| Rate for Payer: AlohaCare Medicare |
$189.39
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Devoted Health Medicare |
$208.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.39
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$102.46 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$115.31
|
| Rate for Payer: AlohaCare Medicare |
$102.46
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$112.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.46
|
|
|
PR MOD SEDAT ENDO SERVICE >5YRS
|
Professional
|
Both
|
$131.15
|
|
|
Service Code
|
HCPCS G0500
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$111.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.42
|
| Rate for Payer: AlohaCare Medicare |
$5.06
|
| Rate for Payer: Cash Price |
$78.69
|
| Rate for Payer: Cash Price |
$78.69
|
| Rate for Payer: Devoted Health Medicare |
$5.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.40
|
| Rate for Payer: Health Management Network Commercial |
$111.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.06
|
| Rate for Payer: University Health Alliance Commercial |
$5.27
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Devoted Health Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.64
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$118.63
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: AlohaCare Medicaid |
$24.09
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$71.18
|
| Rate for Payer: Cash Price |
$71.18
|
| Rate for Payer: Devoted Health Medicare |
$23.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.60
|
| Rate for Payer: Health Management Network Commercial |
$100.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$30.08
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$99.36
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: AlohaCare Medicaid |
$11.94
|
| Rate for Payer: AlohaCare Medicare |
$10.83
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Devoted Health Medicare |
$11.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.30
|
| Rate for Payer: Health Management Network Commercial |
$84.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.83
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 95905 26
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$2.62
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$2.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.62
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$37.38
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Devoted Health Medicare |
$41.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.38
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 95905 TC
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: AlohaCare Medicaid |
$37.99
|
| Rate for Payer: AlohaCare Medicare |
$34.75
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.50
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.75
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$74.39
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: AlohaCare Medicaid |
$30.19
|
| Rate for Payer: AlohaCare Medicare |
$30.74
|
| Rate for Payer: Cash Price |
$44.63
|
| Rate for Payer: Cash Price |
$44.63
|
| Rate for Payer: Devoted Health Medicare |
$33.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.19
|
| Rate for Payer: Health Management Network Commercial |
$63.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.74
|
| Rate for Payer: University Health Alliance Commercial |
$33.81
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$924.30 |
| Max. Negotiated Rate |
$1,867.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,286.55
|
| Rate for Payer: AlohaCare Medicare |
$1,153.25
|
| Rate for Payer: Cash Price |
$1,318.20
|
| Rate for Payer: Cash Price |
$1,318.20
|
| Rate for Payer: Devoted Health Medicare |
$1,268.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,153.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$924.30
|
| Rate for Payer: Health Management Network Commercial |
$1,867.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,383.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,383.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,383.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,286.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,153.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,286.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,153.25
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$2,590.00
|
|
|
Service Code
|
HCPCS 15734
|
| Min. Negotiated Rate |
$1,381.34 |
| Max. Negotiated Rate |
$2,201.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,509.96
|
| Rate for Payer: AlohaCare Medicare |
$1,381.34
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Devoted Health Medicare |
$1,519.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,381.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,406.86
|
| Rate for Payer: Health Management Network Commercial |
$2,201.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,657.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,657.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,657.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,509.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,381.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,509.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,381.34
|
|
|
PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH
|
Professional
|
Both
|
$70.61
|
|
|
Service Code
|
HCPCS 93356
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: AlohaCare Medicaid |
$11.42
|
| Rate for Payer: AlohaCare Medicare |
$9.97
|
| Rate for Payer: Cash Price |
$42.37
|
| Rate for Payer: Cash Price |
$42.37
|
| Rate for Payer: Devoted Health Medicare |
$10.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.10
|
| Rate for Payer: Health Management Network Commercial |
$60.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.97
|
|
|
PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 58146
|
| Min. Negotiated Rate |
$977.86 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,160.68
|
| Rate for Payer: AlohaCare Medicare |
$998.32
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Cash Price |
$1,182.60
|
| Rate for Payer: Devoted Health Medicare |
$1,098.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$998.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$977.86
|
| Rate for Payer: Health Management Network Commercial |
$1,675.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,197.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,197.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,197.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,160.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$998.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,160.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$998.32
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$1,399.93
|
|
|
Service Code
|
HCPCS 69620
|
| Min. Negotiated Rate |
$378.04 |
| Max. Negotiated Rate |
$1,189.94 |
| Rate for Payer: AlohaCare Medicaid |
$525.23
|
| Rate for Payer: AlohaCare Medicare |
$470.71
|
| Rate for Payer: Cash Price |
$839.96
|
| Rate for Payer: Cash Price |
$839.96
|
| Rate for Payer: Devoted Health Medicare |
$517.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$525.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$811.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$470.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$525.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.04
|
| Rate for Payer: Health Management Network Commercial |
$1,189.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$564.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$564.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$564.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$470.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$470.71
|
| Rate for Payer: University Health Alliance Commercial |
$650.32
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$364.14
|
|
|
Service Code
|
HCPCS 69420
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$309.52 |
| Rate for Payer: AlohaCare Medicaid |
$129.23
|
| Rate for Payer: AlohaCare Medicare |
$115.80
|
| Rate for Payer: Cash Price |
$218.48
|
| Rate for Payer: Cash Price |
$218.48
|
| Rate for Payer: Devoted Health Medicare |
$127.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$309.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.80
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 69421
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: AlohaCare Medicaid |
$161.83
|
| Rate for Payer: AlohaCare Medicare |
$144.22
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Devoted Health Medicare |
$158.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.56
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.22
|
|
|
PR NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Professional
|
Both
|
$312.62
|
|
|
Service Code
|
HCPCS 90865
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$265.73 |
| Rate for Payer: AlohaCare Medicare |
$114.84
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Cash Price |
$187.57
|
| Rate for Payer: Devoted Health Medicare |
$126.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.59
|
| Rate for Payer: Health Management Network Commercial |
$265.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.84
|
| Rate for Payer: University Health Alliance Commercial |
$150.24
|
|
|
PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$371.02
|
|
|
Service Code
|
HCPCS 31231
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$315.37 |
| Rate for Payer: AlohaCare Medicaid |
$65.23
|
| Rate for Payer: AlohaCare Medicare |
$54.40
|
| Rate for Payer: Cash Price |
$222.61
|
| Rate for Payer: Cash Price |
$222.61
|
| Rate for Payer: Devoted Health Medicare |
$59.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$315.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.40
|
| Rate for Payer: University Health Alliance Commercial |
$80.51
|
|
|
PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$515.46
|
|
|
Service Code
|
HCPCS 31233
|
| Min. Negotiated Rate |
$117.96 |
| Max. Negotiated Rate |
$438.14 |
| Rate for Payer: AlohaCare Medicaid |
$138.21
|
| Rate for Payer: AlohaCare Medicare |
$117.96
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Cash Price |
$309.28
|
| Rate for Payer: Devoted Health Medicare |
$129.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.92
|
| Rate for Payer: Health Management Network Commercial |
$438.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.96
|
| Rate for Payer: University Health Alliance Commercial |
$179.81
|
|
|
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 31256
|
| Min. Negotiated Rate |
$151.67 |
| Max. Negotiated Rate |
$264.35 |
| Rate for Payer: AlohaCare Medicaid |
$181.35
|
| Rate for Payer: AlohaCare Medicare |
$151.67
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Devoted Health Medicare |
$166.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$263.64
|
| Rate for Payer: Health Management Network Commercial |
$264.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.67
|
|
|
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 31287
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: AlohaCare Medicaid |
$202.34
|
| Rate for Payer: AlohaCare Medicare |
$169.13
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$186.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.20
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.13
|
|
|
PR NASAL/SINUS NDSC DSTRJ CRYOABLATION PST NSL NRV
|
Professional
|
Both
|
$4,597.77
|
|
|
Service Code
|
HCPCS 31243
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$3,908.10 |
| Rate for Payer: AlohaCare Medicaid |
$159.31
|
| Rate for Payer: AlohaCare Medicare |
$134.12
|
| Rate for Payer: Cash Price |
$2,758.66
|
| Rate for Payer: Cash Price |
$2,758.66
|
| Rate for Payer: Devoted Health Medicare |
$147.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$235.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.31
|
| Rate for Payer: Health Management Network Commercial |
$3,908.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.12
|
| Rate for Payer: University Health Alliance Commercial |
$197.32
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$497.94
|
|
|
Service Code
|
HCPCS 31237
|
| Min. Negotiated Rate |
$138.71 |
| Max. Negotiated Rate |
$423.25 |
| Rate for Payer: AlohaCare Medicaid |
$162.87
|
| Rate for Payer: AlohaCare Medicare |
$138.71
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Cash Price |
$298.76
|
| Rate for Payer: Devoted Health Medicare |
$152.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$250.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.66
|
| Rate for Payer: Health Management Network Commercial |
$423.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$162.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.71
|
| Rate for Payer: University Health Alliance Commercial |
$202.64
|
|
