|
PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 28606
|
| Min. Negotiated Rate |
$400.31 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: AlohaCare Medicaid |
$416.30
|
| Rate for Payer: AlohaCare Medicare |
$400.31
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Devoted Health Medicare |
$440.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$402.74
|
| Rate for Payer: Health Management Network Commercial |
$618.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$480.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.31
|
|
|
PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
|
Professional
|
Both
|
$2,863.07
|
|
|
Service Code
|
HCPCS 37197
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$2,433.61 |
| Rate for Payer: AlohaCare Medicaid |
$285.32
|
| Rate for Payer: AlohaCare Medicare |
$254.07
|
| Rate for Payer: Cash Price |
$1,717.84
|
| Rate for Payer: Cash Price |
$1,717.84
|
| Rate for Payer: Devoted Health Medicare |
$279.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$285.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$452.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$254.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$285.32
|
| Rate for Payer: Health Management Network Commercial |
$2,433.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$304.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$304.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$254.07
|
| Rate for Payer: University Health Alliance Commercial |
$393.20
|
|
|
PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 92973
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: AlohaCare Medicaid |
$166.22
|
| Rate for Payer: AlohaCare Medicare |
$77.38
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$85.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.71
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.38
|
|
|
PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN
|
Professional
|
Both
|
$3,083.22
|
|
|
Service Code
|
HCPCS 37187
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: AlohaCare Medicaid |
$374.49
|
| Rate for Payer: AlohaCare Medicare |
$333.91
|
| Rate for Payer: Cash Price |
$1,849.93
|
| Rate for Payer: Cash Price |
$1,849.93
|
| Rate for Payer: Devoted Health Medicare |
$367.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$374.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$595.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$333.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$374.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,049.80
|
| Rate for Payer: Health Management Network Commercial |
$2,620.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$400.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$400.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$333.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$374.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$333.91
|
| Rate for Payer: University Health Alliance Commercial |
$514.02
|
|
|
PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 92924
|
| Min. Negotiated Rate |
$445.31 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: AlohaCare Medicaid |
$594.41
|
| Rate for Payer: AlohaCare Medicare |
$445.31
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Devoted Health Medicare |
$489.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$445.31
|
| Rate for Payer: Health Management Network Commercial |
$861.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$534.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$534.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$594.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$445.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$594.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$445.31
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 92920
|
| Min. Negotiated Rate |
$367.31 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: AlohaCare Medicaid |
$498.42
|
| Rate for Payer: AlohaCare Medicare |
$367.31
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Devoted Health Medicare |
$404.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$367.31
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$440.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$367.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$498.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$367.31
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$496.78 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: AlohaCare Medicaid |
$554.42
|
| Rate for Payer: AlohaCare Medicare |
$496.78
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Devoted Health Medicare |
$546.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$496.78
|
| Rate for Payer: Health Management Network Commercial |
$803.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$596.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$596.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$596.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$554.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$496.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$554.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$496.78
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 92928
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: AlohaCare Medicaid |
$554.57
|
| Rate for Payer: AlohaCare Medicare |
$440.02
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Devoted Health Medicare |
$484.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$600.73
|
| Rate for Payer: Health Management Network Commercial |
$803.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$528.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$554.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$554.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.02
|
|
|
PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 92943
|
| Min. Negotiated Rate |
$601.56 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: AlohaCare Medicaid |
$622.51
|
| Rate for Payer: AlohaCare Medicare |
$601.56
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Devoted Health Medicare |
$661.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.56
|
| Rate for Payer: Health Management Network Commercial |
$902.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$721.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$721.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$721.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$622.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.56
|
|
|
PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 92933
|
| Min. Negotiated Rate |
$525.13 |
| Max. Negotiated Rate |
$901.85 |
| Rate for Payer: AlohaCare Medicaid |
$621.84
|
| Rate for Payer: AlohaCare Medicare |
$525.13
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Devoted Health Medicare |
$577.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.13
|
| Rate for Payer: Health Management Network Commercial |
$901.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$630.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$630.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$630.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$621.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$621.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.13
|
|
|
PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: AlohaCare Medicaid |
$622.70
|
| Rate for Payer: AlohaCare Medicare |
$559.50
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Devoted Health Medicare |
$615.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$559.50
|
| Rate for Payer: Health Management Network Commercial |
$902.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$671.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$671.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$671.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$559.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$622.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$559.50
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$2,665.60
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$2,265.76 |
| Rate for Payer: AlohaCare Medicaid |
$267.18
|
| Rate for Payer: AlohaCare Medicare |
$240.73
|
| Rate for Payer: Cash Price |
$1,599.36
|
| Rate for Payer: Cash Price |
$1,599.36
|
| Rate for Payer: Devoted Health Medicare |
$264.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$267.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$421.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$267.18
|
| Rate for Payer: Health Management Network Commercial |
$2,265.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.73
|
| Rate for Payer: University Health Alliance Commercial |
$366.59
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,115.05
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$429.44 |
| Max. Negotiated Rate |
$947.79 |
| Rate for Payer: AlohaCare Medicaid |
$460.87
|
| Rate for Payer: AlohaCare Medicare |
$429.44
|
| Rate for Payer: Cash Price |
$669.03
|
| Rate for Payer: Cash Price |
$669.03
|
| Rate for Payer: Devoted Health Medicare |
$472.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$460.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$699.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$460.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network Commercial |
$947.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$515.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$515.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$460.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$460.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.44
|
| Rate for Payer: University Health Alliance Commercial |
$574.43
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$635.96 |
| Max. Negotiated Rate |
$1,370.20 |
| Rate for Payer: AlohaCare Medicaid |
$944.77
|
| Rate for Payer: AlohaCare Medicare |
$878.63
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Devoted Health Medicare |
$966.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$878.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$635.96
|
| Rate for Payer: Health Management Network Commercial |
$1,370.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,054.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,054.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,054.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$944.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$878.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$944.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$878.63
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$643.39 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$715.49
|
| Rate for Payer: AlohaCare Medicare |
$643.39
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$707.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$643.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$758.68
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$772.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$772.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$772.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$715.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$643.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$715.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$643.39
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$313.53
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: AlohaCare Medicaid |
$148.43
|
| Rate for Payer: AlohaCare Medicare |
$138.14
|
| Rate for Payer: Cash Price |
$188.12
|
| Rate for Payer: Cash Price |
$188.12
|
| Rate for Payer: Devoted Health Medicare |
$151.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.43
|
| Rate for Payer: Health Management Network Commercial |
$266.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.14
|
| Rate for Payer: University Health Alliance Commercial |
$179.86
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$363.23
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: AlohaCare Medicaid |
$170.34
|
| Rate for Payer: AlohaCare Medicare |
$158.95
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Devoted Health Medicare |
$174.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$170.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$170.34
|
| Rate for Payer: Health Management Network Commercial |
$308.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.95
|
| Rate for Payer: University Health Alliance Commercial |
$205.90
|
|
|
PR PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 90885
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$196.80
|
|
|
Service Code
|
HCPCS 90845
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$167.28 |
| Rate for Payer: AlohaCare Medicaid |
$87.16
|
| Rate for Payer: AlohaCare Medicare |
$88.53
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Devoted Health Medicare |
$97.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.16
|
| Rate for Payer: Health Management Network Commercial |
$167.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.53
|
| Rate for Payer: University Health Alliance Commercial |
$100.92
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$156.10
|
|
|
Service Code
|
HCPCS 96131
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: AlohaCare Medicaid |
$75.36
|
| Rate for Payer: AlohaCare Medicare |
$70.60
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Devoted Health Medicare |
$77.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.07
|
| Rate for Payer: Health Management Network Commercial |
$132.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.60
|
| Rate for Payer: University Health Alliance Commercial |
$94.30
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR
|
Professional
|
Both
|
$223.12
|
|
|
Service Code
|
HCPCS 96130
|
| Min. Negotiated Rate |
$99.78 |
| Max. Negotiated Rate |
$189.65 |
| Rate for Payer: AlohaCare Medicaid |
$109.26
|
| Rate for Payer: AlohaCare Medicare |
$99.78
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Devoted Health Medicare |
$109.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$109.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.00
|
| Rate for Payer: Health Management Network Commercial |
$189.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.78
|
| Rate for Payer: University Health Alliance Commercial |
$129.26
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
Both
|
$26.60
|
|
|
Service Code
|
HCPCS 90785
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: AlohaCare Medicaid |
$13.08
|
| Rate for Payer: AlohaCare Medicare |
$11.78
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Devoted Health Medicare |
$12.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Health Management Network Commercial |
$22.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.78
|
| Rate for Payer: University Health Alliance Commercial |
$14.19
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$139.18
|
|
|
Service Code
|
HCPCS 90840
|
| Min. Negotiated Rate |
$62.82 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: AlohaCare Medicaid |
$64.85
|
| Rate for Payer: AlohaCare Medicare |
$62.82
|
| Rate for Payer: Cash Price |
$83.51
|
| Rate for Payer: Cash Price |
$83.51
|
| Rate for Payer: Devoted Health Medicare |
$69.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.85
|
| Rate for Payer: Health Management Network Commercial |
$118.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.82
|
| Rate for Payer: University Health Alliance Commercial |
$74.62
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$289.36
|
|
|
Service Code
|
HCPCS 90839
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: AlohaCare Medicaid |
$129.79
|
| Rate for Payer: AlohaCare Medicare |
$130.41
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Devoted Health Medicare |
$143.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.79
|
| Rate for Payer: Health Management Network Commercial |
$245.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.41
|
| Rate for Payer: University Health Alliance Commercial |
$149.05
|
|
|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$154.94
|
|
|
Service Code
|
HCPCS 90832
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$131.70 |
| Rate for Payer: AlohaCare Medicaid |
$68.60
|
| Rate for Payer: AlohaCare Medicare |
$69.93
|
| Rate for Payer: Cash Price |
$92.96
|
| Rate for Payer: Cash Price |
$92.96
|
| Rate for Payer: Devoted Health Medicare |
$76.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.60
|
| Rate for Payer: Health Management Network Commercial |
$131.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.93
|
| Rate for Payer: University Health Alliance Commercial |
$80.22
|
|
