|
PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 31240
|
| Min. Negotiated Rate |
$136.81 |
| Max. Negotiated Rate |
$235.45 |
| Rate for Payer: AlohaCare Medicaid |
$161.67
|
| Rate for Payer: AlohaCare Medicare |
$136.81
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Devoted Health Medicare |
$150.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.68
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.81
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$483.61
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: AlohaCare Medicaid |
$170.20
|
| Rate for Payer: AlohaCare Medicare |
$144.57
|
| Rate for Payer: Cash Price |
$290.17
|
| Rate for Payer: Cash Price |
$290.17
|
| Rate for Payer: Devoted Health Medicare |
$159.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$170.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$262.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$170.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.76
|
| Rate for Payer: Health Management Network Commercial |
$411.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.57
|
| Rate for Payer: University Health Alliance Commercial |
$211.23
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS
|
Professional
|
Both
|
$5,849.55
|
|
|
Service Code
|
HCPCS 31298
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$4,972.12 |
| Rate for Payer: AlohaCare Medicaid |
$256.59
|
| Rate for Payer: AlohaCare Medicare |
$213.69
|
| Rate for Payer: Cash Price |
$3,509.73
|
| Rate for Payer: Cash Price |
$3,509.73
|
| Rate for Payer: Devoted Health Medicare |
$235.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$398.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,367.22
|
| Rate for Payer: Health Management Network Commercial |
$4,972.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.69
|
| Rate for Payer: University Health Alliance Commercial |
$250.09
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$3,153.83
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$151.34 |
| Max. Negotiated Rate |
$2,680.76 |
| Rate for Payer: AlohaCare Medicaid |
$180.64
|
| Rate for Payer: AlohaCare Medicare |
$151.34
|
| Rate for Payer: Cash Price |
$1,892.30
|
| Rate for Payer: Cash Price |
$1,892.30
|
| Rate for Payer: Devoted Health Medicare |
$166.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$295.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,588.30
|
| Rate for Payer: Health Management Network Commercial |
$2,680.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.34
|
| Rate for Payer: University Health Alliance Commercial |
$177.19
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,107.09
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$2,641.03 |
| Rate for Payer: AlohaCare Medicaid |
$159.12
|
| Rate for Payer: AlohaCare Medicare |
$134.12
|
| Rate for Payer: Cash Price |
$1,864.25
|
| Rate for Payer: Cash Price |
$1,864.25
|
| Rate for Payer: Devoted Health Medicare |
$147.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,553.72
|
| Rate for Payer: Health Management Network Commercial |
$2,641.03
|
| 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 |
$159.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.12
|
| Rate for Payer: University Health Alliance Commercial |
$155.74
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,084.15
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,621.53 |
| Rate for Payer: AlohaCare Medicaid |
$145.32
|
| Rate for Payer: AlohaCare Medicare |
$122.91
|
| Rate for Payer: Cash Price |
$1,850.49
|
| Rate for Payer: Cash Price |
$1,850.49
|
| Rate for Payer: Devoted Health Medicare |
$135.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$243.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,558.14
|
| Rate for Payer: Health Management Network Commercial |
$2,621.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.91
|
| Rate for Payer: University Health Alliance Commercial |
$190.23
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$369.54 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: AlohaCare Medicaid |
$445.15
|
| Rate for Payer: AlohaCare Medicare |
$369.54
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Devoted Health Medicare |
$406.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$464.36
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$445.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$445.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.54
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$413.53 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: AlohaCare Medicaid |
$498.84
|
| Rate for Payer: AlohaCare Medicare |
$413.53
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Devoted Health Medicare |
$454.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$413.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$521.30
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$496.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$496.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$413.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$413.53
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$390.96 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: AlohaCare Medicaid |
$470.48
|
| Rate for Payer: AlohaCare Medicare |
$390.96
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$430.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$390.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$492.18
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$469.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$469.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$470.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$470.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.96
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$815.74
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$203.72 |
| Max. Negotiated Rate |
$693.38 |
| Rate for Payer: AlohaCare Medicaid |
$244.18
|
| Rate for Payer: AlohaCare Medicare |
$203.72
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Devoted Health Medicare |
$224.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$379.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$244.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.88
|
| Rate for Payer: Health Management Network Commercial |
$693.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.72
|
| Rate for Payer: University Health Alliance Commercial |
$302.76
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$593.58 |
| Rate for Payer: AlohaCare Medicaid |
$378.19
|
| Rate for Payer: AlohaCare Medicare |
$313.54
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Devoted Health Medicare |
$344.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$548.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$378.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$378.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.54
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$269.70 |
| Max. Negotiated Rate |
$560.82 |
| Rate for Payer: AlohaCare Medicaid |
$323.56
|
| Rate for Payer: AlohaCare Medicare |
$269.70
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Devoted Health Medicare |
$296.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.82
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$323.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.70
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: AlohaCare Medicaid |
$39.16
|
| Rate for Payer: AlohaCare Medicare |
$33.82
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.04
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.82
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$224.58
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$190.89 |
| Rate for Payer: AlohaCare Medicaid |
$39.41
|
| Rate for Payer: AlohaCare Medicare |
$33.77
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Devoted Health Medicare |
$37.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.32
|
| Rate for Payer: Health Management Network Commercial |
$190.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.77
|
| Rate for Payer: University Health Alliance Commercial |
$47.15
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 95860 TC
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$77.29
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Devoted Health Medicare |
$85.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.29
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 95860 26
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$123.15 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$53.44
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$58.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.44
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$130.72
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Devoted Health Medicare |
$143.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$266.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.72
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$175.83
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$193.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.83
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95861 TC
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$91.72
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$100.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.72
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 95861 26
|
| Min. Negotiated Rate |
$84.12 |
| Max. Negotiated Rate |
$173.62 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$84.12
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$92.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.12
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 95863 26
|
| Min. Negotiated Rate |
$102.59 |
| Max. Negotiated Rate |
$226.48 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$102.59
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$112.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.59
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 95863 TC
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$138.05
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Devoted Health Medicare |
$151.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.05
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$240.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Devoted Health Medicare |
$264.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.64
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: AlohaCare Medicaid |
$253.41
|
| Rate for Payer: AlohaCare Medicare |
$262.88
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Devoted Health Medicare |
$289.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.17
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$315.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$315.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.88
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 95864 26
|
| Min. Negotiated Rate |
$108.88 |
| Max. Negotiated Rate |
$253.41 |
| Rate for Payer: AlohaCare Medicaid |
$253.41
|
| Rate for Payer: AlohaCare Medicare |
$108.88
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Devoted Health Medicare |
$119.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.17
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.88
|
|
