|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$44.06
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Devoted Health Medicare |
$48.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.28
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.06
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$295.71
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$251.35 |
| Rate for Payer: AlohaCare Medicaid |
$157.37
|
| Rate for Payer: AlohaCare Medicare |
$142.78
|
| Rate for Payer: Cash Price |
$177.43
|
| Rate for Payer: Cash Price |
$177.43
|
| Rate for Payer: Devoted Health Medicare |
$157.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.74
|
| Rate for Payer: Health Management Network Commercial |
$251.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$157.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$157.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.78
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$143.83
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$50.97 |
| Max. Negotiated Rate |
$122.26 |
| Rate for Payer: AlohaCare Medicaid |
$76.70
|
| Rate for Payer: AlohaCare Medicare |
$69.65
|
| Rate for Payer: Cash Price |
$86.30
|
| Rate for Payer: Cash Price |
$86.30
|
| Rate for Payer: Devoted Health Medicare |
$76.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.97
|
| Rate for Payer: Health Management Network Commercial |
$122.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.65
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$208.02
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$176.82 |
| Rate for Payer: AlohaCare Medicaid |
$110.71
|
| Rate for Payer: AlohaCare Medicare |
$100.64
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Devoted Health Medicare |
$110.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.47
|
| Rate for Payer: Health Management Network Commercial |
$176.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.64
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$76.51
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$65.03 |
| Rate for Payer: AlohaCare Medicaid |
$41.45
|
| Rate for Payer: AlohaCare Medicare |
$38.02
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Devoted Health Medicare |
$41.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.59
|
| Rate for Payer: Health Management Network Commercial |
$65.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.02
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,374.38
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$2,018.22 |
| Rate for Payer: AlohaCare Medicaid |
$116.54
|
| Rate for Payer: AlohaCare Medicare |
$103.56
|
| Rate for Payer: Cash Price |
$1,424.63
|
| Rate for Payer: Cash Price |
$1,424.63
|
| Rate for Payer: Devoted Health Medicare |
$113.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$182.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,133.60
|
| Rate for Payer: Health Management Network Commercial |
$2,018.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.56
|
| Rate for Payer: University Health Alliance Commercial |
$162.04
|
|
|
PR SCREENING FOR DEPRESSION PERFORMED
|
Professional
|
Both
|
$16,595.00
|
|
|
Service Code
|
HCPCS 3725F
|
| Min. Negotiated Rate |
$14,105.75 |
| Max. Negotiated Rate |
$14,105.75 |
| Rate for Payer: Cash Price |
$9,957.00
|
| Rate for Payer: Health Management Network Commercial |
$14,105.75
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: AlohaCare Medicaid |
$14.34
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.38
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.34
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.20
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
|
|
PR SCREENING TSTS DIABETES MELLITUS RVWD RQSTD ORD
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 3754F
|
| Min. Negotiated Rate |
$1,673.65 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Cash Price |
$1,181.40
|
| Rate for Payer: Health Management Network Commercial |
$1,673.65
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$266.24 |
| Max. Negotiated Rate |
$583.95 |
| Rate for Payer: AlohaCare Medicaid |
$399.86
|
| Rate for Payer: AlohaCare Medicare |
$368.55
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Devoted Health Medicare |
$405.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.24
|
| Rate for Payer: Health Management Network Commercial |
$583.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$442.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$399.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$399.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.55
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: AlohaCare Medicaid |
$377.12
|
| Rate for Payer: AlohaCare Medicare |
$346.07
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Devoted Health Medicare |
$380.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$346.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.58
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$415.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$415.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$346.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$377.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$346.07
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$1,213.80 |
| Rate for Payer: AlohaCare Medicaid |
$831.15
|
| Rate for Payer: AlohaCare Medicare |
$797.90
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Devoted Health Medicare |
$877.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$797.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.82
|
| Rate for Payer: Health Management Network Commercial |
$1,213.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$957.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$957.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$957.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$831.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$797.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$831.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$797.90
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: AlohaCare Medicaid |
$813.50
|
| Rate for Payer: AlohaCare Medicare |
$749.47
|
| Rate for Payer: Cash Price |
$839.40
|
| Rate for Payer: Cash Price |
$839.40
|
| Rate for Payer: Devoted Health Medicare |
$824.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$749.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network Commercial |
$1,189.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$899.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$899.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$899.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$813.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$749.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$813.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$749.47
|
| Rate for Payer: University Health Alliance Commercial |
$935.34
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$2,231.14
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$205.89 |
| Max. Negotiated Rate |
$1,896.47 |
| Rate for Payer: AlohaCare Medicaid |
$227.38
|
| Rate for Payer: AlohaCare Medicare |
$205.89
|
| Rate for Payer: Cash Price |
$1,338.68
|
| Rate for Payer: Cash Price |
$1,338.68
|
| Rate for Payer: Devoted Health Medicare |
$226.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$227.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$227.38
|
| Rate for Payer: Health Management Network Commercial |
$1,896.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$247.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.89
|
| Rate for Payer: University Health Alliance Commercial |
$365.00
|
|
|
PR SELECT PICTURE AUDIOMETRY
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 92583
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$65.21
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.31
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
|
|
PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 30520
|
| Min. Negotiated Rate |
$479.18 |
| Max. Negotiated Rate |
$1,037.85 |
| Rate for Payer: AlohaCare Medicaid |
$726.27
|
| Rate for Payer: AlohaCare Medicare |
$647.18
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Devoted Health Medicare |
$711.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$647.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$479.18
|
| Rate for Payer: Health Management Network Commercial |
$1,037.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$776.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$776.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$726.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$647.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$726.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$647.18
|
|
|
PR SEQUESTRECTOMY FOREARM &/WRIST
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 25145
|
| Min. Negotiated Rate |
$430.30 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: AlohaCare Medicaid |
$552.71
|
| Rate for Payer: AlohaCare Medicare |
$517.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Devoted Health Medicare |
$568.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$517.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$430.30
|
| Rate for Payer: Health Management Network Commercial |
$807.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$620.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$620.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$552.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$517.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$552.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$517.00
|
|
|
PR SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$901.65
|
|
|
Service Code
|
HCPCS 28315
|
| Min. Negotiated Rate |
$321.17 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: AlohaCare Medicaid |
$342.72
|
| Rate for Payer: AlohaCare Medicare |
$321.17
|
| Rate for Payer: Cash Price |
$540.99
|
| Rate for Payer: Cash Price |
$540.99
|
| Rate for Payer: Devoted Health Medicare |
$353.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$342.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$523.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$367.38
|
| Rate for Payer: Health Management Network Commercial |
$766.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.17
|
| Rate for Payer: University Health Alliance Commercial |
$428.14
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$640.64
|
|
|
Service Code
|
HCPCS 45335
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$544.54 |
| Rate for Payer: AlohaCare Medicaid |
$68.21
|
| Rate for Payer: AlohaCare Medicare |
$63.79
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Devoted Health Medicare |
$70.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.52
|
| Rate for Payer: Health Management Network Commercial |
$544.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.79
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$643.09
|
|
|
Service Code
|
HCPCS 45338
|
| Min. Negotiated Rate |
$109.99 |
| Max. Negotiated Rate |
$546.63 |
| Rate for Payer: AlohaCare Medicaid |
$120.90
|
| Rate for Payer: AlohaCare Medicare |
$109.99
|
| Rate for Payer: Cash Price |
$385.85
|
| Rate for Payer: Cash Price |
$385.85
|
| Rate for Payer: Devoted Health Medicare |
$120.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$194.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.36
|
| Rate for Payer: Health Management Network Commercial |
$546.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.99
|
|
|
PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 45337
|
| Min. Negotiated Rate |
$99.70 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$113.58
|
| Rate for Payer: AlohaCare Medicare |
$99.70
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Devoted Health Medicare |
$109.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.36
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.70
|
|
|
PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 45349
|
| Min. Negotiated Rate |
$176.41 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: AlohaCare Medicare |
$176.41
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Devoted Health Medicare |
$194.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$176.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.42
|
| Rate for Payer: Health Management Network Commercial |
$286.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.41
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<
|
Professional
|
Both
|
$213.45
|
|
|
Service Code
|
HCPCS 11310
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$181.43 |
| Rate for Payer: AlohaCare Medicaid |
$45.90
|
| Rate for Payer: AlohaCare Medicare |
$36.52
|
| Rate for Payer: Cash Price |
$128.07
|
| Rate for Payer: Cash Price |
$128.07
|
| Rate for Payer: Devoted Health Medicare |
$40.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$71.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.24
|
| Rate for Payer: Health Management Network Commercial |
$181.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.52
|
| Rate for Payer: University Health Alliance Commercial |
$52.69
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Professional
|
Both
|
$332.88
|
|
|
Service Code
|
HCPCS 11313
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$282.95 |
| Rate for Payer: AlohaCare Medicaid |
$96.95
|
| Rate for Payer: AlohaCare Medicare |
$77.05
|
| Rate for Payer: Cash Price |
$199.73
|
| Rate for Payer: Cash Price |
$199.73
|
| Rate for Payer: Devoted Health Medicare |
$84.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$150.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$282.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.05
|
| Rate for Payer: University Health Alliance Commercial |
$111.38
|
|
