|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$1,232.66 |
| Max. Negotiated Rate |
$2,073.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,422.04
|
| Rate for Payer: AlohaCare Medicare |
$1,317.68
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Devoted Health Medicare |
$1,449.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,317.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,232.66
|
| Rate for Payer: Health Management Network Commercial |
$2,073.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,581.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,581.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,581.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,422.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,317.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,422.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,317.68
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,396.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$2,886.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,982.14
|
| Rate for Payer: AlohaCare Medicare |
$1,813.11
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Devoted Health Medicare |
$1,994.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,813.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,233.18
|
| Rate for Payer: Health Management Network Commercial |
$2,886.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,175.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,175.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,175.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,982.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,813.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,982.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,813.11
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$953.68 |
| Max. Negotiated Rate |
$2,733.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,876.79
|
| Rate for Payer: AlohaCare Medicare |
$1,718.36
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Devoted Health Medicare |
$1,890.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,718.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$953.68
|
| Rate for Payer: Health Management Network Commercial |
$2,733.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,062.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,062.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,062.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,876.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,718.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,876.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,718.36
|
|
|
PR GSTRCT TOT W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,792.00
|
|
|
Service Code
|
HCPCS 43621
|
| Min. Negotiated Rate |
$1,125.54 |
| Max. Negotiated Rate |
$3,223.20 |
| Rate for Payer: AlohaCare Medicaid |
$2,209.83
|
| Rate for Payer: AlohaCare Medicare |
$2,019.48
|
| Rate for Payer: Cash Price |
$2,275.20
|
| Rate for Payer: Cash Price |
$2,275.20
|
| Rate for Payer: Devoted Health Medicare |
$2,221.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,019.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,125.54
|
| Rate for Payer: Health Management Network Commercial |
$3,223.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,423.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,423.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,423.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,209.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,019.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,209.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,019.48
|
|
|
PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 35572
|
| Min. Negotiated Rate |
$287.31 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: AlohaCare Medicaid |
$316.39
|
| Rate for Payer: AlohaCare Medicare |
$287.31
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Devoted Health Medicare |
$316.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.46
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$344.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$344.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.31
|
|
|
PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 35500
|
| Min. Negotiated Rate |
$268.04 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: AlohaCare Medicaid |
$292.07
|
| Rate for Payer: AlohaCare Medicare |
$268.04
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Devoted Health Medicare |
$294.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$335.14
|
| Rate for Payer: Health Management Network Commercial |
$423.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$292.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$292.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.04
|
|
|
PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Professional
|
Both
|
$194.13
|
|
|
Service Code
|
HCPCS 96156
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$165.01 |
| Rate for Payer: AlohaCare Medicaid |
$88.31
|
| Rate for Payer: AlohaCare Medicare |
$87.38
|
| Rate for Payer: Cash Price |
$116.48
|
| Rate for Payer: Cash Price |
$116.48
|
| Rate for Payer: Devoted Health Medicare |
$96.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$88.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$109.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$88.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.86
|
| Rate for Payer: Health Management Network Commercial |
$165.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.38
|
| Rate for Payer: University Health Alliance Commercial |
$102.27
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN
|
Professional
|
Both
|
$133.26
|
|
|
Service Code
|
HCPCS 96158
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: AlohaCare Medicaid |
$58.99
|
| Rate for Payer: AlohaCare Medicare |
$60.20
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Devoted Health Medicare |
$66.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.60
|
| Rate for Payer: Health Management Network Commercial |
$113.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.20
|
| Rate for Payer: University Health Alliance Commercial |
$69.55
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN
|
Professional
|
Both
|
$45.94
|
|
|
Service Code
|
HCPCS 96159
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: AlohaCare Medicaid |
$19.79
|
| Rate for Payer: AlohaCare Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Devoted Health Medicare |
$22.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.41
|
| Rate for Payer: Health Management Network Commercial |
$39.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.56
|
| Rate for Payer: University Health Alliance Commercial |
$23.57
|
|
|
PR HEMIARTHROPLASTY HIP PARTIAL
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 27125
|
| Min. Negotiated Rate |
$931.06 |
| Max. Negotiated Rate |
$1,687.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,156.11
|
| Rate for Payer: AlohaCare Medicare |
$1,039.51
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Devoted Health Medicare |
$1,143.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,039.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$931.06
|
| Rate for Payer: Health Management Network Commercial |
$1,687.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,247.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,247.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,156.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,039.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,156.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,039.51
|
|
|
PR HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE
|
Professional
|
Both
|
$767.15
|
|
|
Service Code
|
HCPCS 28160
|
| Min. Negotiated Rate |
$248.04 |
| Max. Negotiated Rate |
$652.08 |
| Rate for Payer: AlohaCare Medicaid |
$283.32
|
| Rate for Payer: AlohaCare Medicare |
$265.96
|
| Rate for Payer: Cash Price |
$460.29
|
| Rate for Payer: Cash Price |
$460.29
|
| Rate for Payer: Devoted Health Medicare |
$292.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$283.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$430.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$283.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$248.04
|
| Rate for Payer: Health Management Network Commercial |
$652.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$265.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$283.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.96
|
| Rate for Payer: University Health Alliance Commercial |
$364.15
|
|
|
PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Professional
|
Both
|
$618.48
|
|
|
Service Code
|
HCPCS 46221
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$525.71 |
| Rate for Payer: AlohaCare Medicaid |
$203.28
|
| Rate for Payer: AlohaCare Medicare |
$206.83
|
| Rate for Payer: Cash Price |
$371.09
|
| Rate for Payer: Cash Price |
$371.09
|
| Rate for Payer: Devoted Health Medicare |
$227.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$203.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$317.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$203.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$525.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.83
|
|
|
PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO
|
Professional
|
Both
|
$858.78
|
|
|
Service Code
|
HCPCS 46260
|
| Min. Negotiated Rate |
$490.35 |
| Max. Negotiated Rate |
$729.96 |
| Rate for Payer: AlohaCare Medicaid |
$497.47
|
| Rate for Payer: AlohaCare Medicare |
$490.35
|
| Rate for Payer: Cash Price |
$515.27
|
| Rate for Payer: Cash Price |
$515.27
|
| Rate for Payer: Devoted Health Medicare |
$539.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$490.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$519.48
|
| Rate for Payer: Health Management Network Commercial |
$729.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$588.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$588.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$588.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$497.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$490.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$497.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$490.35
|
|
|
PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP
|
Professional
|
Both
|
$1,087.96
|
|
|
Service Code
|
HCPCS 46255
|
| Min. Negotiated Rate |
$359.65 |
| Max. Negotiated Rate |
$924.77 |
| Rate for Payer: AlohaCare Medicaid |
$367.21
|
| Rate for Payer: AlohaCare Medicare |
$359.65
|
| Rate for Payer: Cash Price |
$652.78
|
| Rate for Payer: Cash Price |
$652.78
|
| Rate for Payer: Devoted Health Medicare |
$395.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$367.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$575.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$367.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.44
|
| Rate for Payer: Health Management Network Commercial |
$924.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.65
|
| Rate for Payer: University Health Alliance Commercial |
$487.39
|
|
|
PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Professional
|
Both
|
$1,007.46
|
|
|
Service Code
|
HCPCS 46250
|
| Min. Negotiated Rate |
$301.34 |
| Max. Negotiated Rate |
$856.34 |
| Rate for Payer: AlohaCare Medicaid |
$331.19
|
| Rate for Payer: AlohaCare Medicare |
$327.70
|
| Rate for Payer: Cash Price |
$604.48
|
| Rate for Payer: Cash Price |
$604.48
|
| Rate for Payer: Devoted Health Medicare |
$360.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$331.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$517.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$327.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$331.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.34
|
| Rate for Payer: Health Management Network Commercial |
$856.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$393.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$327.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$327.70
|
| Rate for Payer: University Health Alliance Commercial |
$438.56
|
|
|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 90633
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.02
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90634
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$81.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.21
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.73
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$75.15
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Devoted Health Medicare |
$82.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.48
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.15
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$75.15
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$82.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.64
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.15
|
|
|
PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 90747
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$164.42
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$180.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$197.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.42
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$33.20
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$36.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.77
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.20
|
|
|
PR HFO WITHOUT JOINTS PRE OTS
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS L3924
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$92.52
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$101.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.25
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.52
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.04
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.55
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
