|
PR PARTIAL EXCISION BONE CLAVICLE
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 23180
|
| Min. Negotiated Rate |
$437.06 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: AlohaCare Medicaid |
$687.95
|
| Rate for Payer: AlohaCare Medicare |
$669.93
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Devoted Health Medicare |
$736.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.06
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$803.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$687.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$687.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.93
|
|
|
PR PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$1,277.99
|
|
|
Service Code
|
HCPCS 28120
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,086.29 |
| Rate for Payer: AlohaCare Medicaid |
$519.05
|
| Rate for Payer: AlohaCare Medicare |
$482.30
|
| Rate for Payer: Cash Price |
$766.79
|
| Rate for Payer: Cash Price |
$766.79
|
| Rate for Payer: Devoted Health Medicare |
$530.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$519.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$719.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$519.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$340.60
|
| Rate for Payer: Health Management Network Commercial |
$1,086.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$578.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$578.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$519.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.30
|
| Rate for Payer: University Health Alliance Commercial |
$674.05
|
|
|
PR PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 27640
|
| Min. Negotiated Rate |
$778.63 |
| Max. Negotiated Rate |
$1,245.25 |
| Rate for Payer: AlohaCare Medicaid |
$858.14
|
| Rate for Payer: AlohaCare Medicare |
$778.63
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Devoted Health Medicare |
$856.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$778.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$889.46
|
| Rate for Payer: Health Management Network Commercial |
$1,245.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$934.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$934.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$934.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$858.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$778.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$858.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$778.63
|
|
|
PR PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 26236
|
| Min. Negotiated Rate |
$322.40 |
| Max. Negotiated Rate |
$689.35 |
| Rate for Payer: AlohaCare Medicaid |
$471.19
|
| Rate for Payer: AlohaCare Medicare |
$436.30
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Devoted Health Medicare |
$479.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$436.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.40
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$523.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$523.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$471.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$436.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$471.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$436.30
|
|
|
PR PARTIAL HYMENECTOMY OR REVISION HYMENAL RING
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 56700
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: AlohaCare Medicaid |
$211.94
|
| Rate for Payer: AlohaCare Medicare |
$184.97
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$203.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.97
|
|
|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$889.32
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$330.45 |
| Max. Negotiated Rate |
$755.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.22
|
| Rate for Payer: AlohaCare Medicare |
$330.45
|
| Rate for Payer: Cash Price |
$533.59
|
| Rate for Payer: Cash Price |
$533.59
|
| Rate for Payer: Devoted Health Medicare |
$363.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$354.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$534.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$354.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$755.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.45
|
| Rate for Payer: University Health Alliance Commercial |
$452.51
|
|
|
PR PATCH/APPLICATION TESTS SPECIFY NUMBER TESTS
|
Professional
|
Both
|
$9.64
|
|
|
Service Code
|
HCPCS 95044
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: AlohaCare Medicaid |
$5.54
|
| Rate for Payer: AlohaCare Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Devoted Health Medicare |
$6.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.58
|
| Rate for Payer: Health Management Network Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.51
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.03
|
| Rate for Payer: Health Management Network Commercial |
$807.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR PCV15 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 90671
|
| Min. Negotiated Rate |
$269.31 |
| Max. Negotiated Rate |
$421.60 |
| Rate for Payer: AlohaCare Medicare |
$269.31
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Devoted Health Medicare |
$296.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.31
|
| Rate for Payer: Health Management Network Commercial |
$421.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.31
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$980.05 |
| Rate for Payer: AlohaCare Medicare |
$312.90
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Devoted Health Medicare |
$344.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$312.90
|
| Rate for Payer: Health Management Network Commercial |
$980.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$375.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$312.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$312.90
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99459
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: AlohaCare Medicaid |
$26.01
|
| Rate for Payer: AlohaCare Medicare |
$19.75
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$21.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.75
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.75
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: AlohaCare Medicaid |
$107.65
|
| Rate for Payer: AlohaCare Medicare |
$96.34
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$105.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.34
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$621.92 |
| Max. Negotiated Rate |
$1,102.45 |
| Rate for Payer: AlohaCare Medicaid |
$756.87
|
| Rate for Payer: AlohaCare Medicare |
$678.45
|
| Rate for Payer: Cash Price |
$778.20
|
| Rate for Payer: Cash Price |
$778.20
|
| Rate for Payer: Devoted Health Medicare |
$746.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$678.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$621.92
|
| Rate for Payer: Health Management Network Commercial |
$1,102.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$814.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$814.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$814.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$756.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$678.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$756.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$678.45
|
|
|
PR PERC DRUG-EL COR STENT SING
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS C9600
|
| Min. Negotiated Rate |
$803.25 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Health Management Network Commercial |
$803.25
|
|
|
PR PERCUTANEOUS TESTS W/ALLERGENIC XTR IMMT RXN
|
Professional
|
Both
|
$6.91
|
|
|
Service Code
|
HCPCS 95004
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: AlohaCare Medicaid |
$3.96
|
| Rate for Payer: AlohaCare Medicare |
$3.95
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Devoted Health Medicare |
$4.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.25
|
| Rate for Payer: Health Management Network Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.95
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$121.81 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$144.07
|
| Rate for Payer: AlohaCare Medicare |
$121.81
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$133.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.81
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.81
|
|
|
PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 33016
|
| Min. Negotiated Rate |
$193.96 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: AlohaCare Medicaid |
$221.95
|
| Rate for Payer: AlohaCare Medicare |
$193.96
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Devoted Health Medicare |
$213.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.96
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$221.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.96
|
|
|
PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE
|
Professional
|
Both
|
$1,264.00
|
|
|
Service Code
|
HCPCS 19371
|
| Min. Negotiated Rate |
$659.45 |
| Max. Negotiated Rate |
$1,074.40 |
| Rate for Payer: AlohaCare Medicaid |
$733.74
|
| Rate for Payer: AlohaCare Medicare |
$659.45
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Devoted Health Medicare |
$725.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$676.26
|
| Rate for Payer: Health Management Network Commercial |
$1,074.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$791.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$791.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$733.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$733.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.45
|
|
|
PR PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 56810
|
| Min. Negotiated Rate |
$201.24 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: AlohaCare Medicaid |
$280.75
|
| Rate for Payer: AlohaCare Medicare |
$241.83
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Devoted Health Medicare |
$266.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.24
|
| Rate for Payer: Health Management Network Commercial |
$402.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.83
|
|
|
PR PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99391
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: AlohaCare Medicaid |
$67.37
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.37
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99394
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AlohaCare Medicaid |
$83.70
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| 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 |
$58.30
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.70
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99392
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: AlohaCare Medicaid |
$73.80
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| 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 |
$47.38
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.80
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99395
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: AlohaCare Medicaid |
$86.32
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.32
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99396
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: AlohaCare Medicaid |
$93.79
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$201.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.79
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 99393
|
| Min. Negotiated Rate |
$52.48 |
| Max. Negotiated Rate |
$170.85 |
| Rate for Payer: AlohaCare Medicaid |
$73.80
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| 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 |
$52.48
|
| Rate for Payer: Health Management Network Commercial |
$170.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.80
|
|
