|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,396.85
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$1,187.32 |
| Rate for Payer: AlohaCare Medicaid |
$583.80
|
| Rate for Payer: AlohaCare Medicare |
$525.91
|
| Rate for Payer: Cash Price |
$838.11
|
| Rate for Payer: Cash Price |
$838.11
|
| Rate for Payer: Devoted Health Medicare |
$578.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$583.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$896.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$583.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.50
|
| Rate for Payer: Health Management Network Commercial |
$1,187.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$631.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$631.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$631.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$583.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$583.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.91
|
| Rate for Payer: University Health Alliance Commercial |
$758.75
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: AlohaCare Medicaid |
$1.75
|
| Rate for Payer: AlohaCare Medicare |
$2.50
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.84
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.50
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: AlohaCare Medicaid |
$1.16
|
| Rate for Payer: AlohaCare Medicare |
$1.64
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.64
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.64
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$486.04
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$184.34 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: AlohaCare Medicaid |
$205.95
|
| Rate for Payer: AlohaCare Medicare |
$186.98
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Devoted Health Medicare |
$205.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$205.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$315.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$186.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$205.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.34
|
| Rate for Payer: Health Management Network Commercial |
$413.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$224.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$186.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$186.98
|
| Rate for Payer: University Health Alliance Commercial |
$256.06
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$489.32 |
| Max. Negotiated Rate |
$1,323.45 |
| Rate for Payer: AlohaCare Medicaid |
$912.60
|
| Rate for Payer: AlohaCare Medicare |
$817.12
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Devoted Health Medicare |
$898.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$817.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$489.32
|
| Rate for Payer: Health Management Network Commercial |
$1,323.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$980.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$980.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$912.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$817.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$912.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$817.12
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$235.22
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$75.93 |
| Max. Negotiated Rate |
$199.94 |
| Rate for Payer: AlohaCare Medicaid |
$83.19
|
| Rate for Payer: AlohaCare Medicare |
$75.93
|
| Rate for Payer: Cash Price |
$141.13
|
| Rate for Payer: Cash Price |
$141.13
|
| Rate for Payer: Devoted Health Medicare |
$83.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.19
|
| Rate for Payer: Health Management Network Commercial |
$199.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.93
|
| Rate for Payer: University Health Alliance Commercial |
$108.03
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$689.57
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$393.66 |
| Max. Negotiated Rate |
$586.13 |
| Rate for Payer: AlohaCare Medicaid |
$398.57
|
| Rate for Payer: AlohaCare Medicare |
$393.66
|
| Rate for Payer: Cash Price |
$413.74
|
| Rate for Payer: Cash Price |
$413.74
|
| Rate for Payer: Devoted Health Medicare |
$433.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.66
|
| Rate for Payer: Health Management Network Commercial |
$586.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$398.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.66
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: AlohaCare Medicaid |
$163.64
|
| Rate for Payer: AlohaCare Medicare |
$155.61
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$171.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.61
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$148.63
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.27
|
| Rate for Payer: AlohaCare Medicare |
$68.98
|
| Rate for Payer: Cash Price |
$89.18
|
| Rate for Payer: Cash Price |
$89.18
|
| Rate for Payer: Devoted Health Medicare |
$75.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.98
|
| Rate for Payer: Health Management Network Commercial |
$126.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.98
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$258.90
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$220.06 |
| Rate for Payer: AlohaCare Medicaid |
$140.18
|
| Rate for Payer: AlohaCare Medicare |
$119.46
|
| Rate for Payer: Cash Price |
$155.34
|
| Rate for Payer: Cash Price |
$155.34
|
| Rate for Payer: Devoted Health Medicare |
$131.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.46
|
| Rate for Payer: Health Management Network Commercial |
$220.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.46
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: AlohaCare Medicaid |
$28.65
|
| Rate for Payer: AlohaCare Medicare |
$29.37
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$32.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.92
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.37
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,187.76
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$437.95 |
| Max. Negotiated Rate |
$1,009.60 |
| Rate for Payer: AlohaCare Medicaid |
$449.29
|
| Rate for Payer: AlohaCare Medicare |
$437.95
|
| Rate for Payer: Cash Price |
$712.66
|
| Rate for Payer: Cash Price |
$712.66
|
| Rate for Payer: Devoted Health Medicare |
$481.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$671.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.16
|
| Rate for Payer: Health Management Network Commercial |
$1,009.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$525.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$525.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$525.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$449.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.95
|
| Rate for Payer: University Health Alliance Commercial |
$491.01
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$349.44 |
| Max. Negotiated Rate |
$962.20 |
| Rate for Payer: AlohaCare Medicaid |
$661.92
|
| Rate for Payer: AlohaCare Medicare |
$626.73
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Devoted Health Medicare |
$689.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.44
|
| Rate for Payer: Health Management Network Commercial |
$962.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.73
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$751.92 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: AlohaCare Medicaid |
$907.77
|
| Rate for Payer: AlohaCare Medicare |
$858.42
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Devoted Health Medicare |
$944.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$858.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.92
|
| Rate for Payer: Health Management Network Commercial |
$1,320.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,030.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,030.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,030.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$907.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$858.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$907.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$858.42
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$746.98 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: AlohaCare Medicaid |
$956.40
|
| Rate for Payer: AlohaCare Medicare |
$904.49
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Devoted Health Medicare |
$994.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$904.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.98
|
| Rate for Payer: Health Management Network Commercial |
$1,394.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,085.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,085.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,085.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$956.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$904.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$956.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$904.49
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,021.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$991.12 |
| Max. Negotiated Rate |
$1,717.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,181.41
|
| Rate for Payer: AlohaCare Medicare |
$1,116.27
|
| Rate for Payer: Cash Price |
$1,212.60
|
| Rate for Payer: Cash Price |
$1,212.60
|
| Rate for Payer: Devoted Health Medicare |
$1,227.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,116.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$991.12
|
| Rate for Payer: Health Management Network Commercial |
$1,717.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,339.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,339.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,339.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,181.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,116.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,181.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,116.27
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: AlohaCare Medicaid |
$814.91
|
| Rate for Payer: AlohaCare Medicare |
$739.87
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Devoted Health Medicare |
$813.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$739.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$666.12
|
| Rate for Payer: Health Management Network Commercial |
$1,190.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$887.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$887.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$887.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$814.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$739.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$814.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$739.87
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$963.25
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$818.76 |
| Rate for Payer: AlohaCare Medicaid |
$326.92
|
| Rate for Payer: AlohaCare Medicare |
$325.43
|
| Rate for Payer: Cash Price |
$577.95
|
| Rate for Payer: Cash Price |
$577.95
|
| Rate for Payer: Devoted Health Medicare |
$357.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$326.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$501.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$325.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$326.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network Commercial |
$818.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$325.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$325.43
|
| Rate for Payer: University Health Alliance Commercial |
$354.70
|
|
|
PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN
|
Professional
|
Both
|
$224.51
|
|
|
Service Code
|
HCPCS 36596
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$190.83 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$41.32
|
| Rate for Payer: Cash Price |
$134.71
|
| Rate for Payer: Cash Price |
$134.71
|
| Rate for Payer: Devoted Health Medicare |
$45.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$68.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$190.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.32
|
| Rate for Payer: University Health Alliance Commercial |
$68.36
|
|
|
PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS
|
Professional
|
Both
|
$1,113.33
|
|
|
Service Code
|
HCPCS 36595
|
| Min. Negotiated Rate |
$155.41 |
| Max. Negotiated Rate |
$946.33 |
| Rate for Payer: AlohaCare Medicaid |
$176.30
|
| Rate for Payer: AlohaCare Medicare |
$155.41
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Devoted Health Medicare |
$170.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.30
|
| Rate for Payer: Health Management Network Commercial |
$946.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.41
|
| Rate for Payer: University Health Alliance Commercial |
$246.52
|
|
|
PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 90710
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.98
|
| Rate for Payer: Health Management Network Commercial |
$495.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 90707
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.64
|
| Rate for Payer: Health Management Network Commercial |
$187.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 51798
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: AlohaCare Medicaid |
$12.81
|
| Rate for Payer: AlohaCare Medicare |
$14.06
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Devoted Health Medicare |
$15.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.98
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.06
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 53020
|
| Min. Negotiated Rate |
$86.15 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: AlohaCare Medicaid |
$96.68
|
| Rate for Payer: AlohaCare Medicare |
$86.15
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Devoted Health Medicare |
$94.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.86
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.15
|
|
|
PR MED ABORTION INC ALL EX DRUG
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS S0199
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$424.51 |
| Rate for Payer: AlohaCare Medicaid |
$424.51
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.52
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$424.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.51
|
|
