|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,715.94
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$669.89 |
| Max. Negotiated Rate |
$1,458.55 |
| Rate for Payer: AlohaCare Medicaid |
$793.63
|
| Rate for Payer: AlohaCare Medicare |
$669.89
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Devoted Health Medicare |
$736.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$793.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,211.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$793.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$756.86
|
| Rate for Payer: Health Management Network Commercial |
$1,458.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$793.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.89
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,638.23
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$491.92 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: AlohaCare Medicaid |
$738.69
|
| Rate for Payer: AlohaCare Medicare |
$637.43
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Devoted Health Medicare |
$701.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$738.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,129.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$738.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$491.92
|
| Rate for Payer: Health Management Network Commercial |
$1,392.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$764.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$738.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$738.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.43
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,852.15
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$673.40 |
| Max. Negotiated Rate |
$1,574.33 |
| Rate for Payer: AlohaCare Medicaid |
$853.08
|
| Rate for Payer: AlohaCare Medicare |
$718.48
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Devoted Health Medicare |
$790.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$853.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,302.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$718.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$853.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$673.40
|
| Rate for Payer: Health Management Network Commercial |
$1,574.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$862.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$853.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$718.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$853.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$718.48
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$391.28
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$332.59 |
| Rate for Payer: AlohaCare Medicaid |
$212.97
|
| Rate for Payer: AlohaCare Medicare |
$178.78
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Devoted Health Medicare |
$196.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.78
|
| Rate for Payer: Health Management Network Commercial |
$332.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.78
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,338.56
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$459.68 |
| Max. Negotiated Rate |
$1,137.78 |
| Rate for Payer: AlohaCare Medicaid |
$596.14
|
| Rate for Payer: AlohaCare Medicare |
$522.98
|
| Rate for Payer: Cash Price |
$803.14
|
| Rate for Payer: Cash Price |
$803.14
|
| Rate for Payer: Devoted Health Medicare |
$575.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$596.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$906.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$596.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$459.68
|
| Rate for Payer: Health Management Network Commercial |
$1,137.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$596.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$596.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.98
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$1,428.24
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: AlohaCare Medicaid |
$694.94
|
| Rate for Payer: AlohaCare Medicare |
$590.94
|
| Rate for Payer: Cash Price |
$856.94
|
| Rate for Payer: Cash Price |
$856.94
|
| Rate for Payer: Devoted Health Medicare |
$650.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$694.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,060.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$590.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$694.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.38
|
| Rate for Payer: Health Management Network Commercial |
$1,214.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$709.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$709.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$709.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$694.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$694.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.94
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,424.48
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$562.59 |
| Max. Negotiated Rate |
$1,210.81 |
| Rate for Payer: AlohaCare Medicaid |
$651.80
|
| Rate for Payer: AlohaCare Medicare |
$562.59
|
| Rate for Payer: Cash Price |
$854.69
|
| Rate for Payer: Cash Price |
$854.69
|
| Rate for Payer: Devoted Health Medicare |
$618.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$651.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$994.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$562.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$651.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$572.52
|
| Rate for Payer: Health Management Network Commercial |
$1,210.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$675.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$675.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$651.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$651.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.59
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: AlohaCare Medicaid |
$469.38
|
| Rate for Payer: AlohaCare Medicare |
$442.15
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Devoted Health Medicare |
$486.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.84
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$530.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$530.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$469.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$469.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.15
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$56.93
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$48.39 |
| Rate for Payer: AlohaCare Medicaid |
$14.77
|
| Rate for Payer: AlohaCare Medicare |
$32.53
|
| Rate for Payer: Cash Price |
$34.16
|
| Rate for Payer: Cash Price |
$34.16
|
| Rate for Payer: Devoted Health Medicare |
$35.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.53
|
| Rate for Payer: Health Management Network Commercial |
$48.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.53
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$46.83
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$39.81 |
| Rate for Payer: AlohaCare Medicaid |
$12.92
|
| Rate for Payer: AlohaCare Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Devoted Health Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.76
|
| Rate for Payer: Health Management Network Commercial |
$39.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.76
|
|
|
PR ADM OF PA/N ASSESS 5-15 M
|
Professional
|
Both
|
$38.12
|
|
|
Service Code
|
HCPCS G0136
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.24
|
| Rate for Payer: Health Management Network Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.10
|
| Rate for Payer: University Health Alliance Commercial |
$8.98
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$157.85
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: AlohaCare Medicaid |
$76.28
|
| Rate for Payer: AlohaCare Medicare |
$66.27
|
| Rate for Payer: Cash Price |
$94.71
|
| Rate for Payer: Cash Price |
$94.71
|
| Rate for Payer: Devoted Health Medicare |
$72.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$76.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.40
|
| Rate for Payer: Health Management Network Commercial |
$134.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.27
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$150.34
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$85.91 |
| Max. Negotiated Rate |
$127.79 |
| Rate for Payer: AlohaCare Medicaid |
$88.91
|
| Rate for Payer: AlohaCare Medicare |
$85.91
|
| Rate for Payer: Cash Price |
$90.20
|
| Rate for Payer: Cash Price |
$90.20
|
| Rate for Payer: Devoted Health Medicare |
$94.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.91
|
| Rate for Payer: Health Management Network Commercial |
$127.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.91
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$149.71
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$85.55 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: AlohaCare Medicaid |
$88.85
|
| Rate for Payer: AlohaCare Medicare |
$85.55
|
| Rate for Payer: Cash Price |
$89.83
|
| Rate for Payer: Cash Price |
$89.83
|
| Rate for Payer: Devoted Health Medicare |
$94.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.55
|
| Rate for Payer: Health Management Network Commercial |
$127.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.55
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 92650
|
| 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 AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$200.69
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$170.59 |
| Rate for Payer: AlohaCare Medicaid |
$119.51
|
| Rate for Payer: AlohaCare Medicare |
$114.68
|
| Rate for Payer: Cash Price |
$120.41
|
| Rate for Payer: Cash Price |
$120.41
|
| Rate for Payer: Devoted Health Medicare |
$126.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.68
|
| Rate for Payer: Health Management Network Commercial |
$170.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.68
|
|
|
PR AFFINITY1 SQUARE CM
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Min. Negotiated Rate |
$144.69 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: AlohaCare Medicare |
$144.69
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Devoted Health Medicare |
$159.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.69
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.69
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$45.66 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: AlohaCare Medicaid |
$45.66
|
| Rate for Payer: AlohaCare Medicare |
$116.17
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Devoted Health Medicare |
$127.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.17
|
|
|
PR AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL
|
Professional
|
Both
|
$5,044.10
|
|
|
Service Code
|
HCPCS 21125
|
| Min. Negotiated Rate |
$474.76 |
| Max. Negotiated Rate |
$4,287.48 |
| Rate for Payer: AlohaCare Medicaid |
$691.02
|
| Rate for Payer: AlohaCare Medicare |
$617.78
|
| Rate for Payer: Cash Price |
$3,026.46
|
| Rate for Payer: Cash Price |
$3,026.46
|
| Rate for Payer: Devoted Health Medicare |
$679.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$691.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,066.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$691.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$474.76
|
| Rate for Payer: Health Management Network Commercial |
$4,287.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$741.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$741.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$741.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$691.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$691.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.78
|
| Rate for Payer: University Health Alliance Commercial |
$902.93
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.00
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$63.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.65
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION [6462]
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
NDC 60977014127
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$796.45 |
| Max. Negotiated Rate |
$908.89 |
| Rate for Payer: Cash Price |
$562.20
|
| Rate for Payer: Health Management Network Commercial |
$796.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$843.30
|
| Rate for Payer: MDX Hawaii PPO |
$908.89
|
|
