|
PR PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$11,648.32
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$431.78 |
| Max. Negotiated Rate |
$9,901.07 |
| Rate for Payer: AlohaCare Medicaid |
$487.12
|
| Rate for Payer: AlohaCare Medicare |
$431.78
|
| Rate for Payer: Cash Price |
$6,988.99
|
| Rate for Payer: Cash Price |
$6,988.99
|
| Rate for Payer: Devoted Health Medicare |
$474.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$487.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$774.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$431.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$487.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,839.26
|
| Rate for Payer: Health Management Network Commercial |
$9,901.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$518.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$518.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$487.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$431.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$487.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$431.78
|
| Rate for Payer: University Health Alliance Commercial |
$720.00
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$4,277.93
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$374.41 |
| Max. Negotiated Rate |
$3,636.24 |
| Rate for Payer: AlohaCare Medicaid |
$423.33
|
| Rate for Payer: AlohaCare Medicare |
$374.41
|
| Rate for Payer: Cash Price |
$2,566.76
|
| Rate for Payer: Cash Price |
$2,566.76
|
| Rate for Payer: Devoted Health Medicare |
$411.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$423.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$675.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$374.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$423.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,585.70
|
| Rate for Payer: Health Management Network Commercial |
$3,636.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$449.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$449.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$423.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$374.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$423.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$374.41
|
| Rate for Payer: University Health Alliance Commercial |
$571.74
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$3,371.13
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$310.07 |
| Max. Negotiated Rate |
$2,865.46 |
| Rate for Payer: AlohaCare Medicaid |
$350.89
|
| Rate for Payer: AlohaCare Medicare |
$310.07
|
| Rate for Payer: Cash Price |
$2,022.68
|
| Rate for Payer: Cash Price |
$2,022.68
|
| Rate for Payer: Devoted Health Medicare |
$341.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$350.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$557.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$350.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,019.68
|
| Rate for Payer: Health Management Network Commercial |
$2,865.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$350.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$350.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.07
|
| Rate for Payer: University Health Alliance Commercial |
$481.78
|
|
|
PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE
|
Professional
|
Both
|
$1,798.00
|
|
|
Service Code
|
HCPCS 93590
|
| Min. Negotiated Rate |
$907.90 |
| Max. Negotiated Rate |
$1,528.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,053.53
|
| Rate for Payer: AlohaCare Medicare |
$907.90
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Devoted Health Medicare |
$998.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$907.90
|
| Rate for Payer: Health Management Network Commercial |
$1,528.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,089.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,089.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,089.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,053.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$907.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,053.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$907.90
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$11,432.26
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$447.89 |
| Max. Negotiated Rate |
$9,717.42 |
| Rate for Payer: AlohaCare Medicaid |
$506.94
|
| Rate for Payer: AlohaCare Medicare |
$447.89
|
| Rate for Payer: Cash Price |
$6,859.36
|
| Rate for Payer: Cash Price |
$6,859.36
|
| Rate for Payer: Devoted Health Medicare |
$492.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$506.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$793.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$506.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,356.66
|
| Rate for Payer: Health Management Network Commercial |
$9,717.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$537.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$537.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$537.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.89
|
| Rate for Payer: University Health Alliance Commercial |
$700.00
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$5,872.18
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$5,080.14 |
| Rate for Payer: AlohaCare Medicaid |
$211.20
|
| Rate for Payer: AlohaCare Medicare |
$182.38
|
| Rate for Payer: Cash Price |
$3,523.31
|
| Rate for Payer: Cash Price |
$3,523.31
|
| Rate for Payer: Devoted Health Medicare |
$200.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$211.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,080.14
|
| Rate for Payer: Health Management Network Commercial |
$4,991.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.38
|
| Rate for Payer: University Health Alliance Commercial |
$298.00
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$11,451.26
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$419.82 |
| Max. Negotiated Rate |
$9,733.57 |
| Rate for Payer: AlohaCare Medicaid |
$473.36
|
| Rate for Payer: AlohaCare Medicare |
$419.82
|
| Rate for Payer: Cash Price |
$6,870.76
|
| Rate for Payer: Cash Price |
$6,870.76
|
| Rate for Payer: Devoted Health Medicare |
$461.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$473.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$751.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$419.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$473.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,314.02
|
| Rate for Payer: Health Management Network Commercial |
$9,733.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$503.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$503.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$473.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$419.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$473.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$419.82
|
| Rate for Payer: University Health Alliance Commercial |
$655.00
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$3,438.84
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$358.25 |
| Max. Negotiated Rate |
$2,923.01 |
| Rate for Payer: AlohaCare Medicaid |
$404.73
|
| Rate for Payer: AlohaCare Medicare |
$358.25
|
| Rate for Payer: Cash Price |
$2,063.30
|
| Rate for Payer: Cash Price |
$2,063.30
|
| Rate for Payer: Devoted Health Medicare |
$394.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$404.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$704.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$404.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,902.94
|
| Rate for Payer: Health Management Network Commercial |
$2,923.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$429.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$429.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$429.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$404.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$404.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.25
|
| Rate for Payer: University Health Alliance Commercial |
$536.21
|
|
|
PR PESSARY REUSABLE NONRUBBER
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.45
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$777.75
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$275.05 |
| Max. Negotiated Rate |
$661.09 |
| Rate for Payer: AlohaCare Medicaid |
$294.75
|
| Rate for Payer: AlohaCare Medicare |
$275.05
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Devoted Health Medicare |
$302.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$294.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$444.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$294.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$314.86
|
| Rate for Payer: Health Management Network Commercial |
$661.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$294.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$294.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.05
|
| Rate for Payer: University Health Alliance Commercial |
$376.45
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.81
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$194.42
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$165.26 |
| Rate for Payer: AlohaCare Medicaid |
$108.60
|
| Rate for Payer: AlohaCare Medicare |
$110.72
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Devoted Health Medicare |
$121.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.61
|
| Rate for Payer: Health Management Network Commercial |
$165.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.72
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 93464 26
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: AlohaCare Medicaid |
$238.48
|
| Rate for Payer: AlohaCare Medicare |
$90.33
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Devoted Health Medicare |
$99.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.33
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$238.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$238.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.33
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 93464 TC
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: AlohaCare Medicaid |
$238.48
|
| Rate for Payer: AlohaCare Medicare |
$154.00
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Devoted Health Medicare |
$169.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.00
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$238.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$238.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.00
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 93464
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: AlohaCare Medicaid |
$238.48
|
| Rate for Payer: AlohaCare Medicare |
$244.33
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Devoted Health Medicare |
$268.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$244.33
|
| Rate for Payer: Health Management Network Commercial |
$532.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$293.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$293.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$293.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$238.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$244.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$238.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$244.33
|
|
|
PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM
|
Professional
|
Both
|
$1,131.74
|
|
|
Service Code
|
HCPCS 15050
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$961.98 |
| Rate for Payer: AlohaCare Medicaid |
$479.65
|
| Rate for Payer: AlohaCare Medicare |
$445.25
|
| Rate for Payer: Cash Price |
$679.04
|
| Rate for Payer: Cash Price |
$679.04
|
| Rate for Payer: Devoted Health Medicare |
$489.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$479.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$747.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$445.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$479.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$961.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$534.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$534.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$479.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$445.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$479.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$445.25
|
| Rate for Payer: University Health Alliance Commercial |
$553.05
|
|
|
PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 44300
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,212.10 |
| Rate for Payer: AlohaCare Medicaid |
$832.91
|
| Rate for Payer: AlohaCare Medicare |
$780.82
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Devoted Health Medicare |
$858.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$780.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$1,212.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$936.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$936.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$936.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$832.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$780.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$832.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$780.82
|
|
|
PR PLACEMENT SETON
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 46020
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: AlohaCare Medicaid |
$117.79
|
| Rate for Payer: AlohaCare Medicare |
$111.09
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$122.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$219.96
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$133.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.09
|
|
|
PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 34709
|
| Min. Negotiated Rate |
$269.47 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: AlohaCare Medicaid |
$296.17
|
| Rate for Payer: AlohaCare Medicare |
$269.47
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Devoted Health Medicare |
$296.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.56
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$296.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.47
|
| Rate for Payer: University Health Alliance Commercial |
$467.88
|
|
|
PR PLASTIC OPERATION PENIS INJURY
|
Professional
|
Both
|
$3,074.00
|
|
|
Service Code
|
HCPCS 54440
|
| Min. Negotiated Rate |
$1,485.24 |
| Max. Negotiated Rate |
$2,612.90 |
| Rate for Payer: Cash Price |
$1,844.40
|
| Rate for Payer: Cash Price |
$1,844.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,485.24
|
| Rate for Payer: Health Management Network Commercial |
$2,612.90
|
|
|
PR PLASTIC RPR PENIS CORRECT ANGULATION
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 54360
|
| Min. Negotiated Rate |
$556.66 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: AlohaCare Medicaid |
$730.69
|
| Rate for Payer: AlohaCare Medicare |
$655.42
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Devoted Health Medicare |
$720.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$655.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.66
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$786.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$786.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$730.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$655.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$730.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$655.42
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 94726 TC
|
| Min. Negotiated Rate |
$58.49 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$62.38
|
| Rate for Payer: AlohaCare Medicare |
$58.49
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$64.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.23
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.49
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 94726
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: AlohaCare Medicaid |
$62.38
|
| Rate for Payer: AlohaCare Medicare |
$70.83
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Devoted Health Medicare |
$77.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.23
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.83
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 94726 26
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$62.38 |
| Rate for Payer: AlohaCare Medicaid |
$62.38
|
| Rate for Payer: AlohaCare Medicare |
$12.34
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$13.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.23
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.34
|
|
