|
PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW
|
Professional
|
Both
|
$2,274.25
|
|
|
Service Code
|
HCPCS 47541
|
| Min. Negotiated Rate |
$287.86 |
| Max. Negotiated Rate |
$1,933.11 |
| Rate for Payer: AlohaCare Medicaid |
$324.96
|
| Rate for Payer: AlohaCare Medicare |
$287.86
|
| Rate for Payer: Cash Price |
$1,364.55
|
| Rate for Payer: Cash Price |
$1,364.55
|
| Rate for Payer: Devoted Health Medicare |
$316.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$324.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$510.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$324.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,353.82
|
| Rate for Payer: Health Management Network Commercial |
$1,933.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.86
|
| Rate for Payer: University Health Alliance Commercial |
$432.45
|
|
|
PR PLMT BILE DUCT STENT PRQ EXISTING ACCESS
|
Professional
|
Both
|
$6,906.92
|
|
|
Service Code
|
HCPCS 47538
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$5,870.88 |
| Rate for Payer: AlohaCare Medicaid |
$226.93
|
| Rate for Payer: AlohaCare Medicare |
$199.25
|
| Rate for Payer: Cash Price |
$4,144.15
|
| Rate for Payer: Cash Price |
$4,144.15
|
| Rate for Payer: Devoted Health Medicare |
$219.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$226.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$483.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$226.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,277.74
|
| Rate for Payer: Health Management Network Commercial |
$5,870.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.25
|
|
|
PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH
|
Professional
|
Both
|
$7,810.08
|
|
|
Service Code
|
HCPCS 47539
|
| Min. Negotiated Rate |
$359.50 |
| Max. Negotiated Rate |
$6,638.57 |
| Rate for Payer: AlohaCare Medicaid |
$410.56
|
| Rate for Payer: AlohaCare Medicare |
$359.50
|
| Rate for Payer: Cash Price |
$4,686.05
|
| Rate for Payer: Cash Price |
$4,686.05
|
| Rate for Payer: Devoted Health Medicare |
$395.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$410.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$653.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$410.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,754.32
|
| Rate for Payer: Health Management Network Commercial |
$6,638.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.50
|
| Rate for Payer: University Health Alliance Commercial |
$544.53
|
|
|
PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH
|
Professional
|
Both
|
$7,777.65
|
|
|
Service Code
|
HCPCS 47540
|
| Min. Negotiated Rate |
$369.84 |
| Max. Negotiated Rate |
$6,611.00 |
| Rate for Payer: AlohaCare Medicaid |
$422.93
|
| Rate for Payer: AlohaCare Medicare |
$369.84
|
| Rate for Payer: Cash Price |
$4,666.59
|
| Rate for Payer: Cash Price |
$4,666.59
|
| Rate for Payer: Devoted Health Medicare |
$406.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$422.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$780.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$422.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,972.20
|
| Rate for Payer: Health Management Network Commercial |
$6,611.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$422.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.84
|
| Rate for Payer: University Health Alliance Commercial |
$567.92
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,674.72
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$176.18 |
| Max. Negotiated Rate |
$1,423.51 |
| Rate for Payer: AlohaCare Medicaid |
$200.29
|
| Rate for Payer: AlohaCare Medicare |
$176.18
|
| Rate for Payer: Cash Price |
$1,004.83
|
| Rate for Payer: Cash Price |
$1,004.83
|
| Rate for Payer: Devoted Health Medicare |
$193.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$200.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$325.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$176.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$200.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$968.50
|
| Rate for Payer: Health Management Network Commercial |
$1,423.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$200.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.18
|
|
|
PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$2,083.30
|
|
|
Service Code
|
HCPCS 50433
|
| Min. Negotiated Rate |
$217.12 |
| Max. Negotiated Rate |
$1,770.81 |
| Rate for Payer: AlohaCare Medicaid |
$247.81
|
| Rate for Payer: AlohaCare Medicare |
$217.12
|
| Rate for Payer: Cash Price |
$1,249.98
|
| Rate for Payer: Cash Price |
$1,249.98
|
| Rate for Payer: Devoted Health Medicare |
$238.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$247.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$401.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$217.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$247.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,306.24
|
| Rate for Payer: Health Management Network Commercial |
$1,770.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$217.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$217.12
|
|
|
PR PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT
|
Professional
|
Both
|
$938.18
|
|
|
Service Code
|
HCPCS 32553
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$797.45 |
| Rate for Payer: AlohaCare Medicaid |
$171.56
|
| Rate for Payer: AlohaCare Medicare |
$149.88
|
| Rate for Payer: Cash Price |
$562.91
|
| Rate for Payer: Cash Price |
$562.91
|
| Rate for Payer: Devoted Health Medicare |
$164.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$286.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.56
|
| Rate for Payer: Health Management Network Commercial |
$797.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.88
|
| Rate for Payer: University Health Alliance Commercial |
$230.16
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$915.45 |
| Max. Negotiated Rate |
$1,503.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,042.65
|
| Rate for Payer: AlohaCare Medicare |
$915.45
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Devoted Health Medicare |
$1,007.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$915.45
|
| Rate for Payer: Health Management Network Commercial |
$1,503.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,098.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,098.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,042.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$915.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,042.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$915.45
|
|
|
PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
HCPCS 50695
|
| Min. Negotiated Rate |
$289.87 |
| Max. Negotiated Rate |
$1,552.95 |
| Rate for Payer: AlohaCare Medicaid |
$332.56
|
| Rate for Payer: AlohaCare Medicare |
$289.87
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Cash Price |
$1,096.20
|
| Rate for Payer: Devoted Health Medicare |
$318.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$332.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$526.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$332.56
|
| Rate for Payer: Health Management Network Commercial |
$1,552.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$347.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.87
|
| Rate for Payer: University Health Alliance Commercial |
$444.23
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$1,839.51
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$1,563.58 |
| Rate for Payer: AlohaCare Medicaid |
$199.34
|
| Rate for Payer: AlohaCare Medicare |
$175.03
|
| Rate for Payer: Cash Price |
$1,103.71
|
| Rate for Payer: Cash Price |
$1,103.71
|
| Rate for Payer: Devoted Health Medicare |
$192.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,132.56
|
| Rate for Payer: Health Management Network Commercial |
$1,563.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.03
|
|
|
PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
|
Professional
|
Both
|
$2,053.14
|
|
|
Service Code
|
HCPCS 50694
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$1,745.17 |
| Rate for Payer: AlohaCare Medicaid |
$259.82
|
| Rate for Payer: AlohaCare Medicare |
$226.84
|
| Rate for Payer: Cash Price |
$1,231.88
|
| Rate for Payer: Cash Price |
$1,231.88
|
| Rate for Payer: Devoted Health Medicare |
$249.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$259.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$416.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$259.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,236.56
|
| Rate for Payer: Health Management Network Commercial |
$1,745.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$259.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.84
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: AlohaCare Medicaid |
$180.68
|
| Rate for Payer: AlohaCare Medicare |
$166.14
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Devoted Health Medicare |
$182.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.14
|
| Rate for Payer: Health Management Network Commercial |
$262.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$199.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$199.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.14
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$999.96 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,538.31
|
| Rate for Payer: AlohaCare Medicare |
$1,418.72
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Devoted Health Medicare |
$1,560.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,418.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$999.96
|
| Rate for Payer: Health Management Network Commercial |
$2,238.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,702.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,702.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,702.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,538.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,418.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,538.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,418.72
|
|
|
PR PNEUMA/VAC WALK BOOT PRE OTS
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS L4361
|
| Min. Negotiated Rate |
$307.64 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: AlohaCare Medicaid |
$307.64
|
| Rate for Payer: AlohaCare Medicare |
$400.91
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Devoted Health Medicare |
$441.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$307.64
|
| Rate for Payer: Health Management Network Commercial |
$584.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$307.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.91
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$234.22
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$199.09 |
| Rate for Payer: AlohaCare Medicaid |
$86.15
|
| Rate for Payer: AlohaCare Medicare |
$78.01
|
| Rate for Payer: Cash Price |
$140.53
|
| Rate for Payer: Cash Price |
$140.53
|
| Rate for Payer: Devoted Health Medicare |
$85.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$199.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.01
|
| Rate for Payer: University Health Alliance Commercial |
$107.04
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.41
|
| Rate for Payer: Health Management Network Commercial |
$149.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$464.62 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: AlohaCare Medicaid |
$629.12
|
| Rate for Payer: AlohaCare Medicare |
$544.43
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Devoted Health Medicare |
$598.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$544.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$464.62
|
| Rate for Payer: Health Management Network Commercial |
$908.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$653.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$653.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$653.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$629.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$544.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$629.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$544.43
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$464.24
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$394.60 |
| Rate for Payer: AlohaCare Medicaid |
$172.57
|
| Rate for Payer: AlohaCare Medicare |
$151.93
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Cash Price |
$278.54
|
| Rate for Payer: Devoted Health Medicare |
$167.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.04
|
| Rate for Payer: Health Management Network Commercial |
$394.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.93
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$226.26
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: AlohaCare Medicaid |
$29.88
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$135.76
|
| Rate for Payer: Cash Price |
$135.76
|
| Rate for Payer: Devoted Health Medicare |
$28.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.88
|
| Rate for Payer: Health Management Network Commercial |
$192.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$36.64
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: AlohaCare Medicaid |
$5.90
|
| Rate for Payer: AlohaCare Medicare |
$5.83
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Devoted Health Medicare |
$6.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.83
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$320.55
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$272.47 |
| Rate for Payer: AlohaCare Medicaid |
$173.87
|
| Rate for Payer: AlohaCare Medicare |
$183.17
|
| Rate for Payer: Cash Price |
$192.33
|
| Rate for Payer: Cash Price |
$192.33
|
| Rate for Payer: Devoted Health Medicare |
$201.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$181.50
|
| Rate for Payer: Health Management Network Commercial |
$272.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.17
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$254.87
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$216.64 |
| Rate for Payer: AlohaCare Medicaid |
$137.48
|
| Rate for Payer: AlohaCare Medicare |
$145.26
|
| Rate for Payer: Cash Price |
$152.92
|
| Rate for Payer: Cash Price |
$152.92
|
| Rate for Payer: Devoted Health Medicare |
$159.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$122.58
|
| Rate for Payer: Health Management Network Commercial |
$216.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.26
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$133.47
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$146.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.45
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.47
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$834.60 |
| Max. Negotiated Rate |
$1,572.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.57
|
| Rate for Payer: AlohaCare Medicare |
$1,001.17
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Devoted Health Medicare |
$1,101.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,001.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$834.60
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,201.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,201.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,201.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,001.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,001.17
|
|
|
PR PREPARATION MOULAGE CUSTOM BREAST IMPLANT
|
Professional
|
Both
|
$550.50
|
|
|
Service Code
|
HCPCS 19396
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$467.93 |
| Rate for Payer: AlohaCare Medicaid |
$144.72
|
| Rate for Payer: AlohaCare Medicare |
$126.58
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Devoted Health Medicare |
$139.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.52
|
| Rate for Payer: Health Management Network Commercial |
$467.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.58
|
| Rate for Payer: University Health Alliance Commercial |
$166.12
|
|
