|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$380.34
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$323.29 |
| Rate for Payer: AlohaCare Medicaid |
$135.57
|
| Rate for Payer: AlohaCare Medicare |
$111.77
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Devoted Health Medicare |
$122.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.78
|
| Rate for Payer: Health Management Network Commercial |
$323.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.77
|
| Rate for Payer: University Health Alliance Commercial |
$152.64
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$792.07
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$136.26 |
| Max. Negotiated Rate |
$673.26 |
| Rate for Payer: AlohaCare Medicaid |
$149.86
|
| Rate for Payer: AlohaCare Medicare |
$136.26
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Devoted Health Medicare |
$149.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$149.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.98
|
| Rate for Payer: Health Management Network Commercial |
$673.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.26
|
| Rate for Payer: University Health Alliance Commercial |
$195.96
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$308.02
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$85.63
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Devoted Health Medicare |
$94.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$188.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$261.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.63
|
| Rate for Payer: University Health Alliance Commercial |
$115.54
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: AlohaCare Medicaid |
$59.29
|
| Rate for Payer: AlohaCare Medicare |
$50.49
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$55.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.12
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.49
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: AlohaCare Medicaid |
$2.10
|
| Rate for Payer: AlohaCare Medicare |
$1.72
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.72
|
| Rate for Payer: University Health Alliance Commercial |
$2.43
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$84.01 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.01
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
|
|
PR DIAB MANAGE TRN IND/GROUP
|
Professional
|
Both
|
$29.58
|
|
|
Service Code
|
HCPCS G0109
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: AlohaCare Medicaid |
$16.54
|
| Rate for Payer: AlohaCare Medicare |
$16.90
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Devoted Health Medicare |
$18.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network Commercial |
$25.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.90
|
|
|
PR DIAB MANAGE TRN PER INDIV
|
Professional
|
Both
|
$102.48
|
|
|
Service Code
|
HCPCS G0108
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$87.11 |
| Rate for Payer: AlohaCare Medicaid |
$57.10
|
| Rate for Payer: AlohaCare Medicare |
$58.56
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Devoted Health Medicare |
$64.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.73
|
| Rate for Payer: Health Management Network Commercial |
$87.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.56
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$342.68 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: AlohaCare Medicaid |
$492.40
|
| Rate for Payer: AlohaCare Medicare |
$460.95
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Devoted Health Medicare |
$507.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$460.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.68
|
| Rate for Payer: Health Management Network Commercial |
$724.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$553.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$553.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$460.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$492.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$460.95
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$321.98
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$273.68 |
| Rate for Payer: AlohaCare Medicaid |
$68.20
|
| Rate for Payer: AlohaCare Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$193.19
|
| Rate for Payer: Cash Price |
$193.19
|
| Rate for Payer: Devoted Health Medicare |
$61.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.16
|
| Rate for Payer: Health Management Network Commercial |
$273.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.01
|
| Rate for Payer: University Health Alliance Commercial |
$93.68
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$319.36
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$271.46 |
| Rate for Payer: AlohaCare Medicaid |
$71.25
|
| Rate for Payer: AlohaCare Medicare |
$57.93
|
| Rate for Payer: Cash Price |
$191.62
|
| Rate for Payer: Cash Price |
$191.62
|
| Rate for Payer: Devoted Health Medicare |
$63.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.94
|
| Rate for Payer: Health Management Network Commercial |
$271.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.93
|
| Rate for Payer: University Health Alliance Commercial |
$94.65
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$336.79
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$62.19 |
| Max. Negotiated Rate |
$286.27 |
| Rate for Payer: AlohaCare Medicaid |
$75.42
|
| Rate for Payer: AlohaCare Medicare |
$62.19
|
| Rate for Payer: Cash Price |
$202.07
|
| Rate for Payer: Cash Price |
$202.07
|
| Rate for Payer: Devoted Health Medicare |
$68.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.32
|
| Rate for Payer: Health Management Network Commercial |
$286.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.19
|
| Rate for Payer: University Health Alliance Commercial |
$110.00
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$309.33
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$262.93 |
| Rate for Payer: AlohaCare Medicaid |
$61.33
|
| Rate for Payer: AlohaCare Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Devoted Health Medicare |
$61.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.68
|
| Rate for Payer: Health Management Network Commercial |
$262.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.99
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$409.92
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$72.46 |
| Max. Negotiated Rate |
$348.43 |
| Rate for Payer: AlohaCare Medicaid |
$84.48
|
| Rate for Payer: AlohaCare Medicare |
$72.46
|
| Rate for Payer: Cash Price |
$245.95
|
| Rate for Payer: Cash Price |
$245.95
|
| Rate for Payer: Devoted Health Medicare |
$79.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.50
|
| Rate for Payer: Health Management Network Commercial |
$348.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.46
|
| Rate for Payer: University Health Alliance Commercial |
$119.37
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$3,563.35
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$3,028.85 |
| Rate for Payer: AlohaCare Medicaid |
$190.20
|
| Rate for Payer: AlohaCare Medicare |
$168.88
|
| Rate for Payer: Cash Price |
$2,138.01
|
| Rate for Payer: Cash Price |
$2,138.01
|
| Rate for Payer: Devoted Health Medicare |
$185.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$190.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$190.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,260.96
|
| Rate for Payer: Health Management Network Commercial |
$3,028.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.88
|
| Rate for Payer: University Health Alliance Commercial |
$270.00
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 95957 TC
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$236.23
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Devoted Health Medicare |
$259.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$236.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$600.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$283.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$283.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.23
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 95957 26
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$324.41 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$105.31
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$115.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.31
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$341.54
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Devoted Health Medicare |
$375.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$341.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$756.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$409.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$409.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$409.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$341.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$341.54
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$148.72
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$126.41 |
| Rate for Payer: AlohaCare Medicaid |
$42.14
|
| Rate for Payer: AlohaCare Medicare |
$37.89
|
| Rate for Payer: Cash Price |
$89.23
|
| Rate for Payer: Cash Price |
$89.23
|
| Rate for Payer: Devoted Health Medicare |
$41.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.88
|
| Rate for Payer: Health Management Network Commercial |
$126.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.89
|
| Rate for Payer: University Health Alliance Commercial |
$54.79
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$544.92
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$210.36 |
| Max. Negotiated Rate |
$463.18 |
| Rate for Payer: AlohaCare Medicaid |
$240.48
|
| Rate for Payer: AlohaCare Medicare |
$210.36
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Devoted Health Medicare |
$231.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$240.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$374.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$210.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$240.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.36
|
| Rate for Payer: University Health Alliance Commercial |
$316.81
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$167.09
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$142.03 |
| Rate for Payer: AlohaCare Medicaid |
$62.97
|
| Rate for Payer: AlohaCare Medicare |
$55.61
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Devoted Health Medicare |
$61.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$62.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$97.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$142.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.61
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$166.51
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$141.53 |
| Rate for Payer: AlohaCare Medicaid |
$53.22
|
| Rate for Payer: AlohaCare Medicare |
$47.68
|
| Rate for Payer: Cash Price |
$99.91
|
| Rate for Payer: Cash Price |
$99.91
|
| Rate for Payer: Devoted Health Medicare |
$52.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.96
|
| Rate for Payer: Health Management Network Commercial |
$141.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.68
|
| Rate for Payer: University Health Alliance Commercial |
$69.37
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: AlohaCare Medicaid |
$62.81
|
| Rate for Payer: AlohaCare Medicare |
$54.72
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Devoted Health Medicare |
$60.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.70
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.72
|
|
|
PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 90700
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.13
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$2,806.00
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,502.84 |
| Max. Negotiated Rate |
$2,515.28 |
| Rate for Payer: AlohaCare Medicaid |
$1,643.41
|
| Rate for Payer: AlohaCare Medicare |
$1,502.84
|
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Devoted Health Medicare |
$1,653.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,502.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,686.88
|
| Rate for Payer: Health Management Network Commercial |
$2,385.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,803.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,803.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,803.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,643.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,502.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,643.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,502.84
|
| Rate for Payer: University Health Alliance Commercial |
$2,515.28
|
|
