|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$815.74
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$203.72 |
| Max. Negotiated Rate |
$693.38 |
| Rate for Payer: AlohaCare Medicaid |
$244.18
|
| Rate for Payer: AlohaCare Medicare |
$203.72
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Cash Price |
$489.44
|
| Rate for Payer: Devoted Health Medicare |
$224.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$379.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$244.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.88
|
| Rate for Payer: Health Management Network Commercial |
$693.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.72
|
| Rate for Payer: University Health Alliance Commercial |
$302.76
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$593.58 |
| Rate for Payer: AlohaCare Medicaid |
$378.19
|
| Rate for Payer: AlohaCare Medicare |
$313.54
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Devoted Health Medicare |
$344.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$548.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$378.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$378.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.54
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$269.70 |
| Max. Negotiated Rate |
$560.82 |
| Rate for Payer: AlohaCare Medicaid |
$323.56
|
| Rate for Payer: AlohaCare Medicare |
$269.70
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Devoted Health Medicare |
$296.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.82
|
| Rate for Payer: Health Management Network Commercial |
$470.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$323.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.70
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: AlohaCare Medicaid |
$39.16
|
| Rate for Payer: AlohaCare Medicare |
$33.82
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.04
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.82
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$224.58
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$190.89 |
| Rate for Payer: AlohaCare Medicaid |
$39.41
|
| Rate for Payer: AlohaCare Medicare |
$33.77
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Devoted Health Medicare |
$37.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.32
|
| Rate for Payer: Health Management Network Commercial |
$190.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.77
|
| Rate for Payer: University Health Alliance Commercial |
$47.15
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 95860 26
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$123.15 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$53.44
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$58.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.44
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 95860 TC
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$77.29
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Devoted Health Medicare |
$85.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.29
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: AlohaCare Medicaid |
$123.15
|
| Rate for Payer: AlohaCare Medicare |
$130.72
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Devoted Health Medicare |
$143.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.59
|
| Rate for Payer: Health Management Network Commercial |
$266.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.72
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 95861 26
|
| Min. Negotiated Rate |
$84.12 |
| Max. Negotiated Rate |
$173.62 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$84.12
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$92.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.12
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95861 TC
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$91.72
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$100.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.72
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AlohaCare Medicaid |
$173.62
|
| Rate for Payer: AlohaCare Medicare |
$175.83
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Devoted Health Medicare |
$193.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.91
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.83
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 95863 TC
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$138.05
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Devoted Health Medicare |
$151.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.05
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 95863 26
|
| Min. Negotiated Rate |
$102.59 |
| Max. Negotiated Rate |
$226.48 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$102.59
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$112.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.59
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: AlohaCare Medicaid |
$226.48
|
| Rate for Payer: AlohaCare Medicare |
$240.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Devoted Health Medicare |
$264.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.71
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.64
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 95864 TC
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: AlohaCare Medicaid |
$253.41
|
| Rate for Payer: AlohaCare Medicare |
$154.00
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$169.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.17
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.00
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: AlohaCare Medicaid |
$253.41
|
| Rate for Payer: AlohaCare Medicare |
$262.88
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Devoted Health Medicare |
$289.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$262.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.17
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$315.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$315.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.88
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 95864 26
|
| Min. Negotiated Rate |
$108.88 |
| Max. Negotiated Rate |
$253.41 |
| Rate for Payer: AlohaCare Medicaid |
$253.41
|
| Rate for Payer: AlohaCare Medicare |
$108.88
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Devoted Health Medicare |
$119.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.17
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.88
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 51785 TC
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: AlohaCare Medicaid |
$484.23
|
| Rate for Payer: AlohaCare Medicare |
$339.33
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Devoted Health Medicare |
$373.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$955.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$407.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$407.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$484.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.33
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 51785
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: AlohaCare Medicaid |
$484.23
|
| Rate for Payer: AlohaCare Medicare |
$429.90
|
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Devoted Health Medicare |
$472.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$1,090.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$515.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$515.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$484.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.90
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 51785 26
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$484.23 |
| Rate for Payer: AlohaCare Medicaid |
$484.23
|
| Rate for Payer: AlohaCare Medicare |
$90.57
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$99.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$484.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.57
|
|
|
PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$473.57
|
|
|
Service Code
|
HCPCS 44385
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$402.53 |
| Rate for Payer: AlohaCare Medicaid |
$73.72
|
| Rate for Payer: AlohaCare Medicare |
$68.19
|
| Rate for Payer: Cash Price |
$284.14
|
| Rate for Payer: Cash Price |
$284.14
|
| Rate for Payer: Devoted Health Medicare |
$75.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$402.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.19
|
| Rate for Payer: University Health Alliance Commercial |
$96.49
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$674.94
|
|
|
Service Code
|
HCPCS 44386
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$573.70 |
| Rate for Payer: AlohaCare Medicaid |
$90.20
|
| Rate for Payer: AlohaCare Medicare |
$82.25
|
| Rate for Payer: Cash Price |
$404.96
|
| Rate for Payer: Cash Price |
$404.96
|
| Rate for Payer: Devoted Health Medicare |
$90.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$129.74
|
| Rate for Payer: Health Management Network Commercial |
$573.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.25
|
| Rate for Payer: University Health Alliance Commercial |
$118.73
|
|
|
PR NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 51715
|
| Min. Negotiated Rate |
$173.98 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: AlohaCare Medicaid |
$197.94
|
| Rate for Payer: AlohaCare Medicare |
$173.98
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Devoted Health Medicare |
$191.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$197.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$307.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$197.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$255.84
|
| Rate for Payer: Health Management Network Commercial |
$546.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$197.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.98
|
| Rate for Payer: University Health Alliance Commercial |
$260.27
|
|
|
PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 29848
|
| Min. Negotiated Rate |
$395.98 |
| Max. Negotiated Rate |
$796.45 |
| Rate for Payer: AlohaCare Medicaid |
$543.95
|
| Rate for Payer: AlohaCare Medicare |
$501.12
|
| Rate for Payer: Cash Price |
$562.20
|
| Rate for Payer: Cash Price |
$562.20
|
| Rate for Payer: Devoted Health Medicare |
$551.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$501.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.98
|
| Rate for Payer: Health Management Network Commercial |
$796.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$501.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$543.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$501.12
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 95868 TC
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$151.70 |
| Rate for Payer: AlohaCare Medicaid |
$151.70
|
| Rate for Payer: AlohaCare Medicare |
$76.53
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$84.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.45
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.53
|
|
