|
PR RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 49622
|
| Min. Negotiated Rate |
$813.62 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: AlohaCare Medicaid |
$889.02
|
| Rate for Payer: AlohaCare Medicare |
$813.62
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Devoted Health Medicare |
$894.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$813.62
|
| Rate for Payer: Health Management Network Commercial |
$1,319.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$976.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$976.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$889.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$813.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$889.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$813.62
|
|
|
PR RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 27695
|
| Min. Negotiated Rate |
$428.22 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: AlohaCare Medicaid |
$511.70
|
| Rate for Payer: AlohaCare Medicare |
$479.57
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Devoted Health Medicare |
$527.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$479.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$428.22
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$575.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$575.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$479.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$479.57
|
|
|
PR RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27652
|
| Min. Negotiated Rate |
$618.02 |
| Max. Negotiated Rate |
$1,007.25 |
| Rate for Payer: AlohaCare Medicaid |
$696.51
|
| Rate for Payer: AlohaCare Medicare |
$627.05
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Devoted Health Medicare |
$689.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$627.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.02
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$696.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.05
|
|
|
PR RPR RECRT FEM HRNA INCARCERATED
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 49557
|
| Min. Negotiated Rate |
$458.38 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: AlohaCare Medicaid |
$719.20
|
| Rate for Payer: AlohaCare Medicare |
$680.43
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Devoted Health Medicare |
$748.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$680.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$458.38
|
| Rate for Payer: Health Management Network Commercial |
$1,046.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$816.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$816.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$816.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$719.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$680.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$719.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$680.43
|
|
|
PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 49520
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: AlohaCare Medicaid |
$632.99
|
| Rate for Payer: AlohaCare Medicare |
$599.28
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Devoted Health Medicare |
$659.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$599.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$522.34
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$719.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$719.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$719.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$599.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$632.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$599.28
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$449.28 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$713.60
|
| Rate for Payer: AlohaCare Medicare |
$673.28
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$740.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$673.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.28
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$807.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$807.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$807.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$713.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$673.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$713.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$673.28
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$453.44 |
| Max. Negotiated Rate |
$1,068.45 |
| Rate for Payer: AlohaCare Medicaid |
$733.10
|
| Rate for Payer: AlohaCare Medicare |
$692.55
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Devoted Health Medicare |
$761.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.44
|
| Rate for Payer: Health Management Network Commercial |
$1,068.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$831.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$831.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$733.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$733.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.55
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$978.35 |
| Rate for Payer: AlohaCare Medicaid |
$669.63
|
| Rate for Payer: AlohaCare Medicare |
$624.18
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Devoted Health Medicare |
$686.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$624.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$465.92
|
| Rate for Payer: Health Management Network Commercial |
$978.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$749.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$749.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$669.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$624.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$669.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$624.18
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$565.76 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: AlohaCare Medicaid |
$671.98
|
| Rate for Payer: AlohaCare Medicare |
$617.29
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Devoted Health Medicare |
$679.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.76
|
| Rate for Payer: Health Management Network Commercial |
$984.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$740.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$740.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$671.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$671.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.29
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$445.64 |
| Max. Negotiated Rate |
$770.10 |
| Rate for Payer: AlohaCare Medicaid |
$525.74
|
| Rate for Payer: AlohaCare Medicare |
$485.75
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Devoted Health Medicare |
$534.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$485.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.64
|
| Rate for Payer: Health Management Network Commercial |
$770.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$582.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$582.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$485.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$485.75
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$373.62 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: AlohaCare Medicaid |
$590.82
|
| Rate for Payer: AlohaCare Medicare |
$549.40
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Devoted Health Medicare |
$604.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$549.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.62
|
| Rate for Payer: Health Management Network Commercial |
$862.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$659.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$659.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$549.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$590.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$549.40
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$279.24 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: AlohaCare Medicaid |
$392.17
|
| Rate for Payer: AlohaCare Medicare |
$360.38
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Devoted Health Medicare |
$396.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$360.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.24
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$392.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$360.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$392.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$360.38
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$475.54 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: AlohaCare Medicaid |
$535.89
|
| Rate for Payer: AlohaCare Medicare |
$491.18
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Devoted Health Medicare |
$540.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$491.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.54
|
| Rate for Payer: Health Management Network Commercial |
$784.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$589.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$589.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$535.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$491.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$535.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$491.18
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$404.99 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: AlohaCare Medicaid |
$466.65
|
| Rate for Payer: AlohaCare Medicare |
$404.99
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Devoted Health Medicare |
$445.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$404.99
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$485.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$485.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$485.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$404.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.99
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AlohaCare Medicaid |
$304.21
|
| Rate for Payer: AlohaCare Medicare |
$269.72
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$296.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.72
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$304.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$304.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.72
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$210.96
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: AlohaCare Medicaid |
$58.38
|
| Rate for Payer: AlohaCare Medicare |
$51.05
|
| Rate for Payer: Cash Price |
$126.58
|
| Rate for Payer: Cash Price |
$126.58
|
| Rate for Payer: Devoted Health Medicare |
$56.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.38
|
| Rate for Payer: Health Management Network Commercial |
$179.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.05
|
| Rate for Payer: University Health Alliance Commercial |
$72.75
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$2,183.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$1,855.55 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Health Management Network Commercial |
$1,855.55
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$927.35 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,721.58
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$291.70 |
| Max. Negotiated Rate |
$2,313.34 |
| Rate for Payer: AlohaCare Medicaid |
$329.95
|
| Rate for Payer: AlohaCare Medicare |
$291.70
|
| Rate for Payer: Cash Price |
$1,632.95
|
| Rate for Payer: Cash Price |
$1,632.95
|
| Rate for Payer: Devoted Health Medicare |
$320.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$329.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$525.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$329.95
|
| Rate for Payer: Health Management Network Commercial |
$2,313.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$350.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$350.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$329.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$329.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.70
|
| Rate for Payer: University Health Alliance Commercial |
$526.00
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.96
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.39
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$493.74 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: AlohaCare Medicaid |
$813.42
|
| Rate for Payer: AlohaCare Medicare |
$726.35
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Devoted Health Medicare |
$798.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$493.74
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$871.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$871.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$813.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$813.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.35
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$694.54 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: AlohaCare Medicaid |
$775.77
|
| Rate for Payer: AlohaCare Medicare |
$694.54
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Devoted Health Medicare |
$763.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$694.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network Commercial |
$1,122.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$833.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$833.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$833.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$775.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$694.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$775.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$694.54
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: AlohaCare Medicaid |
$119.20
|
| Rate for Payer: AlohaCare Medicare |
$107.19
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Devoted Health Medicare |
$117.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.28
|
| Rate for Payer: Health Management Network Commercial |
$172.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.19
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: AlohaCare Medicaid |
$79.26
|
| Rate for Payer: AlohaCare Medicare |
$70.62
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Devoted Health Medicare |
$77.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.57
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.62
|
|
