|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$388.66 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: AlohaCare Medicaid |
$435.14
|
| Rate for Payer: AlohaCare Medicare |
$388.66
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Devoted Health Medicare |
$427.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$388.66
|
| Rate for Payer: Health Management Network Commercial |
$633.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$466.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$466.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$388.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$388.66
|
|
|
PR PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN
|
Professional
|
Both
|
$34.42
|
|
|
Service Code
|
HCPCS 95165
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$29.26 |
| Rate for Payer: AlohaCare Medicaid |
$3.33
|
| Rate for Payer: AlohaCare Medicare |
$2.58
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Devoted Health Medicare |
$2.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.70
|
| Rate for Payer: Health Management Network Commercial |
$29.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.58
|
| Rate for Payer: University Health Alliance Commercial |
$3.76
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$748.81
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$228.13 |
| Max. Negotiated Rate |
$636.49 |
| Rate for Payer: AlohaCare Medicaid |
$260.04
|
| Rate for Payer: AlohaCare Medicare |
$228.13
|
| Rate for Payer: Cash Price |
$449.29
|
| Rate for Payer: Cash Price |
$449.29
|
| Rate for Payer: Devoted Health Medicare |
$250.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$260.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$260.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.76
|
| Rate for Payer: Health Management Network Commercial |
$636.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.13
|
| Rate for Payer: University Health Alliance Commercial |
$301.68
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$224.32
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$190.67 |
| Rate for Payer: AlohaCare Medicaid |
$87.34
|
| Rate for Payer: AlohaCare Medicare |
$75.39
|
| Rate for Payer: Cash Price |
$134.59
|
| Rate for Payer: Cash Price |
$134.59
|
| Rate for Payer: Devoted Health Medicare |
$82.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$139.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.34
|
| Rate for Payer: Health Management Network Commercial |
$190.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.39
|
| Rate for Payer: University Health Alliance Commercial |
$103.56
|
|
|
PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$672.70
|
|
|
Service Code
|
HCPCS 15002
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$571.79 |
| Rate for Payer: AlohaCare Medicaid |
$218.73
|
| Rate for Payer: AlohaCare Medicare |
$195.66
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Cash Price |
$403.62
|
| Rate for Payer: Devoted Health Medicare |
$215.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$218.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$341.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$218.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$295.88
|
| Rate for Payer: Health Management Network Commercial |
$571.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$234.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.66
|
| Rate for Payer: University Health Alliance Commercial |
$252.86
|
|
|
PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$136.74
|
|
|
Service Code
|
HCPCS 15003
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: AlohaCare Medicaid |
$43.76
|
| Rate for Payer: AlohaCare Medicare |
$38.27
|
| Rate for Payer: Cash Price |
$82.04
|
| Rate for Payer: Cash Price |
$82.04
|
| Rate for Payer: Devoted Health Medicare |
$42.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$43.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$69.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.76
|
| Rate for Payer: Health Management Network Commercial |
$116.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.27
|
| Rate for Payer: University Health Alliance Commercial |
$51.52
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 94640
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: AlohaCare Medicaid |
$8.98
|
| Rate for Payer: AlohaCare Medicare |
$9.69
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$10.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.69
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 99401
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.55
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 99402
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.12
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 45 MIN
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 99403
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.78
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 60 MIN
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 99404
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.71
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 93279
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: AlohaCare Medicaid |
$73.07
|
| Rate for Payer: AlohaCare Medicare |
$72.51
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$79.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.55
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.51
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 93279 TC
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: AlohaCare Medicaid |
$73.07
|
| Rate for Payer: AlohaCare Medicare |
$40.83
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Devoted Health Medicare |
$44.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.55
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.83
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 93279 26
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$73.07 |
| Rate for Payer: AlohaCare Medicaid |
$73.07
|
| Rate for Payer: AlohaCare Medicare |
$31.68
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$34.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.55
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.68
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 93260
|
| Min. Negotiated Rate |
$72.92 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: AlohaCare Medicaid |
$81.44
|
| Rate for Payer: AlohaCare Medicare |
$81.28
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$89.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.92
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.28
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 93260 26
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$81.44 |
| Rate for Payer: AlohaCare Medicaid |
$81.44
|
| Rate for Payer: AlohaCare Medicare |
$41.97
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$46.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.92
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.97
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 93260 TC
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$81.44 |
| Rate for Payer: AlohaCare Medicaid |
$81.44
|
| Rate for Payer: AlohaCare Medicare |
$39.31
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$43.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.92
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.31
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 93285 TC
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: AlohaCare Medicaid |
$65.30
|
| Rate for Payer: AlohaCare Medicare |
$38.93
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Devoted Health Medicare |
$42.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.93
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.93
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 93285
|
| Min. Negotiated Rate |
$64.71 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: AlohaCare Medicaid |
$65.30
|
| Rate for Payer: AlohaCare Medicare |
$64.71
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Devoted Health Medicare |
$71.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.71
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.71
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93285 26
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$65.30 |
| Rate for Payer: AlohaCare Medicaid |
$65.30
|
| Rate for Payer: AlohaCare Medicare |
$25.78
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$28.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.78
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.78
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 93284 26
|
| Min. Negotiated Rate |
$60.89 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: AlohaCare Medicaid |
$112.92
|
| Rate for Payer: AlohaCare Medicare |
$60.89
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Devoted Health Medicare |
$66.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.64
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.89
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 93284
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: AlohaCare Medicaid |
$112.92
|
| Rate for Payer: AlohaCare Medicare |
$111.97
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Devoted Health Medicare |
$123.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.64
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.97
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$139.40 |
| Rate for Payer: AlohaCare Medicaid |
$112.92
|
| Rate for Payer: AlohaCare Medicare |
$51.08
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Devoted Health Medicare |
$56.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.64
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.08
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 93283
|
| Min. Negotiated Rate |
$85.07 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: AlohaCare Medicaid |
$104.62
|
| Rate for Payer: AlohaCare Medicare |
$103.70
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Devoted Health Medicare |
$114.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.07
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.70
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 93283 TC
|
| Min. Negotiated Rate |
$47.66 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: AlohaCare Medicaid |
$104.62
|
| Rate for Payer: AlohaCare Medicare |
$47.66
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Devoted Health Medicare |
$52.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.07
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.66
|
|
