|
PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 99397
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$218.45 |
| Rate for Payer: AlohaCare Medicaid |
$98.65
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$218.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.65
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 93286 26
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: AlohaCare Medicaid |
$49.75
|
| Rate for Payer: AlohaCare Medicare |
$14.82
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$16.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.82
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.82
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 93286 TC
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: AlohaCare Medicaid |
$49.75
|
| Rate for Payer: AlohaCare Medicare |
$33.99
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$37.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.99
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.99
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 93286
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: AlohaCare Medicaid |
$49.75
|
| Rate for Payer: AlohaCare Medicare |
$48.81
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$53.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.81
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.81
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 93287
|
| Min. Negotiated Rate |
$56.29 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: AlohaCare Medicaid |
$57.04
|
| Rate for Payer: AlohaCare Medicare |
$56.29
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$61.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.29
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.29
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 93287 TC
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: AlohaCare Medicaid |
$57.04
|
| Rate for Payer: AlohaCare Medicare |
$33.99
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$37.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.99
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.99
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 93287 26
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: AlohaCare Medicaid |
$57.04
|
| Rate for Payer: AlohaCare Medicare |
$22.30
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Devoted Health Medicare |
$24.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.30
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.30
|
|
|
PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 49084
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: AlohaCare Medicaid |
$102.52
|
| Rate for Payer: AlohaCare Medicare |
$91.50
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Devoted Health Medicare |
$100.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.50
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.50
|
|
|
PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 34713
|
| Min. Negotiated Rate |
$102.98 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: AlohaCare Medicaid |
$113.16
|
| Rate for Payer: AlohaCare Medicare |
$102.98
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Devoted Health Medicare |
$113.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.56
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.98
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 19285
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$576.30 |
| Rate for Payer: AlohaCare Medicaid |
$82.71
|
| Rate for Payer: AlohaCare Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Devoted Health Medicare |
$77.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$131.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$534.56
|
| Rate for Payer: Health Management Network Commercial |
$576.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.70
|
| Rate for Payer: University Health Alliance Commercial |
$89.84
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Professional
|
Both
|
$561.31
|
|
|
Service Code
|
HCPCS 19286
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$477.11 |
| Rate for Payer: AlohaCare Medicaid |
$41.45
|
| Rate for Payer: AlohaCare Medicare |
$35.54
|
| Rate for Payer: Cash Price |
$336.79
|
| Rate for Payer: Cash Price |
$336.79
|
| Rate for Payer: Devoted Health Medicare |
$39.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.18
|
| Rate for Payer: Health Management Network Commercial |
$477.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.54
|
| Rate for Payer: University Health Alliance Commercial |
$44.92
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$136.02 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: AlohaCare Medicaid |
$148.06
|
| Rate for Payer: AlohaCare Medicare |
$136.02
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Devoted Health Medicare |
$149.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.02
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.02
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$222.56 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: AlohaCare Medicaid |
$244.04
|
| Rate for Payer: AlohaCare Medicare |
$222.56
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Devoted Health Medicare |
$244.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.56
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.56
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$1,254.87
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$1,066.64 |
| Rate for Payer: AlohaCare Medicaid |
$145.60
|
| Rate for Payer: AlohaCare Medicare |
$126.91
|
| Rate for Payer: Cash Price |
$752.92
|
| Rate for Payer: Cash Price |
$752.92
|
| Rate for Payer: Devoted Health Medicare |
$139.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.60
|
| Rate for Payer: Health Management Network Commercial |
$1,066.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.91
|
| Rate for Payer: University Health Alliance Commercial |
$180.63
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$1,643.16
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$1,396.69 |
| Rate for Payer: AlohaCare Medicaid |
$120.34
|
| Rate for Payer: AlohaCare Medicare |
$109.16
|
| Rate for Payer: Cash Price |
$985.90
|
| Rate for Payer: Cash Price |
$985.90
|
| Rate for Payer: Devoted Health Medicare |
$120.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$609.44
|
| Rate for Payer: Health Management Network Commercial |
$1,396.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.16
|
| Rate for Payer: University Health Alliance Commercial |
$164.44
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$996.98 |
| Max. Negotiated Rate |
$1,637.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,125.37
|
| Rate for Payer: AlohaCare Medicare |
$996.98
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Devoted Health Medicare |
$1,096.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$996.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,378.52
|
| Rate for Payer: Health Management Network Commercial |
$1,637.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,196.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,196.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,196.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$996.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,125.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$996.98
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,206.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$630.28 |
| Max. Negotiated Rate |
$1,025.10 |
| Rate for Payer: AlohaCare Medicaid |
$703.86
|
| Rate for Payer: AlohaCare Medicare |
$630.28
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Devoted Health Medicare |
$693.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$630.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.58
|
| Rate for Payer: Health Management Network Commercial |
$1,025.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$756.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$756.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$703.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$630.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$703.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$630.28
|
|
|
PR PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 33019
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: AlohaCare Medicaid |
$203.77
|
| Rate for Payer: AlohaCare Medicare |
$175.30
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$192.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.30
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.30
|
|
|
PR PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 33018
|
| Min. Negotiated Rate |
$238.18 |
| Max. Negotiated Rate |
$396.10 |
| Rate for Payer: AlohaCare Medicaid |
$272.90
|
| Rate for Payer: AlohaCare Medicare |
$238.18
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Devoted Health Medicare |
$262.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$238.18
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$238.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$272.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$238.18
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$203.46 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: AlohaCare Medicaid |
$234.02
|
| Rate for Payer: AlohaCare Medicare |
$203.46
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Devoted Health Medicare |
$223.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.46
|
| Rate for Payer: Health Management Network Commercial |
$339.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.46
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$531.56
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$32.98 |
| Max. Negotiated Rate |
$451.83 |
| Rate for Payer: AlohaCare Medicaid |
$35.99
|
| Rate for Payer: AlohaCare Medicare |
$32.98
|
| Rate for Payer: Cash Price |
$318.94
|
| Rate for Payer: Cash Price |
$318.94
|
| Rate for Payer: Devoted Health Medicare |
$36.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$56.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.54
|
| Rate for Payer: Health Management Network Commercial |
$451.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.98
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$721.58
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$613.34 |
| Rate for Payer: AlohaCare Medicaid |
$87.55
|
| Rate for Payer: AlohaCare Medicare |
$83.07
|
| Rate for Payer: Cash Price |
$432.95
|
| Rate for Payer: Cash Price |
$432.95
|
| Rate for Payer: Devoted Health Medicare |
$91.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.70
|
| Rate for Payer: Health Management Network Commercial |
$613.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.07
|
| Rate for Payer: University Health Alliance Commercial |
$113.30
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$621.92 |
| Max. Negotiated Rate |
$1,037.85 |
| Rate for Payer: AlohaCare Medicaid |
$709.21
|
| Rate for Payer: AlohaCare Medicare |
$660.97
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Devoted Health Medicare |
$727.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$660.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$621.92
|
| Rate for Payer: Health Management Network Commercial |
$1,037.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$793.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$709.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$660.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$709.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$660.97
|
|
|
PR PERQ TCAT PLMT NTRAC ST 2+LES 2+ST 2+C SEGMENTS
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
HCPCS 92930
|
| Min. Negotiated Rate |
$503.65 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: AlohaCare Medicare |
$503.65
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Devoted Health Medicare |
$554.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$503.65
|
| Rate for Payer: Health Management Network Commercial |
$748.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$604.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$604.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$604.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$503.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$503.65
|
|
|
PR PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Min. Negotiated Rate |
$723.35 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
|
