|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$260.42
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$221.36 |
| Rate for Payer: AlohaCare Medicaid |
$57.36
|
| Rate for Payer: AlohaCare Medicare |
$55.77
|
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Devoted Health Medicare |
$61.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$57.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.28
|
| Rate for Payer: Health Management Network Commercial |
$221.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.77
|
| Rate for Payer: University Health Alliance Commercial |
$140.00
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$390.62
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: AlohaCare Medicaid |
$90.64
|
| Rate for Payer: AlohaCare Medicare |
$85.36
|
| Rate for Payer: Cash Price |
$234.37
|
| Rate for Payer: Cash Price |
$234.37
|
| Rate for Payer: Devoted Health Medicare |
$93.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$332.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.36
|
| Rate for Payer: University Health Alliance Commercial |
$106.30
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$442.56
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$376.18 |
| Rate for Payer: AlohaCare Medicaid |
$111.28
|
| Rate for Payer: AlohaCare Medicare |
$104.02
|
| Rate for Payer: Cash Price |
$265.54
|
| Rate for Payer: Cash Price |
$265.54
|
| Rate for Payer: Devoted Health Medicare |
$114.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$169.52
|
| Rate for Payer: Health Management Network Commercial |
$376.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.02
|
| Rate for Payer: University Health Alliance Commercial |
$130.81
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$33.08
|
| Rate for Payer: AlohaCare Medicare |
$33.61
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$36.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.29
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.61
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: AlohaCare Medicaid |
$51.44
|
| Rate for Payer: AlohaCare Medicare |
$52.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$57.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.77
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.60
|
|
|
PR SPEECH AUDIOM THRESHLD AUTO W/SPEECH RECOGNITION
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 0211T
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$592.36
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$503.51 |
| Rate for Payer: AlohaCare Medicaid |
$159.59
|
| Rate for Payer: AlohaCare Medicare |
$150.13
|
| Rate for Payer: Cash Price |
$355.42
|
| Rate for Payer: Cash Price |
$355.42
|
| Rate for Payer: Devoted Health Medicare |
$165.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$188.50
|
| Rate for Payer: Health Management Network Commercial |
$503.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$159.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.13
|
| Rate for Payer: University Health Alliance Commercial |
$213.56
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: AlohaCare Medicaid |
$252.46
|
| Rate for Payer: AlohaCare Medicare |
$226.07
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Devoted Health Medicare |
$248.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.16
|
| Rate for Payer: Health Management Network Commercial |
$367.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$271.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$252.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.07
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$736.84 |
| Max. Negotiated Rate |
$1,643.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,128.66
|
| Rate for Payer: AlohaCare Medicare |
$1,044.28
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Cash Price |
$1,159.80
|
| Rate for Payer: Devoted Health Medicare |
$1,148.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,044.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$736.84
|
| Rate for Payer: Health Management Network Commercial |
$1,643.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,253.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,253.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,128.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,044.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,128.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,044.28
|
|
|
PR SPLINT SUPPLIES MISC
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS Q4051
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,606.46
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$476.32 |
| Max. Negotiated Rate |
$1,365.49 |
| Rate for Payer: AlohaCare Medicaid |
$709.84
|
| Rate for Payer: AlohaCare Medicare |
$623.47
|
| Rate for Payer: Cash Price |
$963.88
|
| Rate for Payer: Cash Price |
$963.88
|
| Rate for Payer: Devoted Health Medicare |
$685.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$709.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,094.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$623.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$709.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.32
|
| Rate for Payer: Health Management Network Commercial |
$1,365.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$748.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$748.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$748.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$709.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$623.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$709.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$623.47
|
| Rate for Payer: University Health Alliance Commercial |
$809.96
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$410.66
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$349.06 |
| Rate for Payer: AlohaCare Medicaid |
$132.18
|
| Rate for Payer: AlohaCare Medicare |
$118.83
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Devoted Health Medicare |
$130.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$220.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.54
|
| Rate for Payer: Health Management Network Commercial |
$349.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$142.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.83
|
| Rate for Payer: University Health Alliance Commercial |
$157.78
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$1,696.03
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$532.74 |
| Max. Negotiated Rate |
$1,441.63 |
| Rate for Payer: AlohaCare Medicaid |
$735.82
|
| Rate for Payer: AlohaCare Medicare |
$671.05
|
| Rate for Payer: Cash Price |
$1,017.62
|
| Rate for Payer: Cash Price |
$1,017.62
|
| Rate for Payer: Devoted Health Medicare |
$738.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$735.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,139.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$671.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$735.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$532.74
|
| Rate for Payer: Health Management Network Commercial |
$1,441.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$805.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$805.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$805.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$735.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$671.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$735.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$671.05
|
| Rate for Payer: University Health Alliance Commercial |
$843.33
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$374.90
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$99.54 |
| Max. Negotiated Rate |
$318.67 |
| Rate for Payer: AlohaCare Medicaid |
$110.25
|
| Rate for Payer: AlohaCare Medicare |
$99.54
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Devoted Health Medicare |
$109.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$110.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$176.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$110.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$318.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.54
|
| Rate for Payer: University Health Alliance Commercial |
$130.25
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 94010 TC
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: AlohaCare Medicaid |
$30.13
|
| Rate for Payer: AlohaCare Medicare |
$24.12
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$26.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.23
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.12
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 94010 26
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: AlohaCare Medicaid |
$30.13
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.23
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$30.13
|
| Rate for Payer: AlohaCare Medicare |
$32.65
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Devoted Health Medicare |
$35.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.23
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.65
|
|
|
PR SPORTS CARDIO CONSULT
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 98364
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
|
|
PR SPORTS CARDIO CT CALCIUM SCORE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 98363
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
|
|
PR SPORTS CARDIO ECG APPL REC & INT
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 98367
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
|
|
PR SPORTS CARDIO ECHO
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 98361
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
|
|
PR SPORTS CARDIOLOGY EKG
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 98399
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
|
|
PR SPORTS CARDIO TREADMILL STRESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 98362
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
|
|
PR SPORTS PHYSICAL EST PT
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 98366
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
|
|
PR SPORTS PHYSICAL NEW PT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 98365
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
|
