|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 95909
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$291.55 |
| Rate for Payer: AlohaCare Medicaid |
$144.94
|
| Rate for Payer: AlohaCare Medicare |
$153.42
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Devoted Health Medicare |
$168.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.12
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.42
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 95909 TC
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$144.94
|
| Rate for Payer: AlohaCare Medicare |
$70.07
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Devoted Health Medicare |
$77.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.12
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.07
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 95910
|
| Min. Negotiated Rate |
$189.12 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: AlohaCare Medicaid |
$189.12
|
| Rate for Payer: AlohaCare Medicare |
$199.60
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$219.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.08
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.60
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 95910 TC
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$189.12
|
| Rate for Payer: AlohaCare Medicare |
$89.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Devoted Health Medicare |
$97.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.08
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.06
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 95910 26
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$200.08 |
| Rate for Payer: AlohaCare Medicaid |
$189.12
|
| Rate for Payer: AlohaCare Medicare |
$110.54
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Devoted Health Medicare |
$121.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.08
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.54
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95911 TC
|
| Min. Negotiated Rate |
$99.31 |
| Max. Negotiated Rate |
$241.74 |
| Rate for Payer: AlohaCare Medicaid |
$227.55
|
| Rate for Payer: AlohaCare Medicare |
$99.31
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Devoted Health Medicare |
$109.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.74
|
| Rate for Payer: Health Management Network Commercial |
$239.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.31
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 95911
|
| Min. Negotiated Rate |
$227.55 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: AlohaCare Medicaid |
$227.55
|
| Rate for Payer: AlohaCare Medicare |
$237.24
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Devoted Health Medicare |
$260.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.74
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$284.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$284.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.24
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 95911 26
|
| Min. Negotiated Rate |
$137.93 |
| Max. Negotiated Rate |
$241.74 |
| Rate for Payer: AlohaCare Medicaid |
$227.55
|
| Rate for Payer: AlohaCare Medicare |
$137.93
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$151.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.74
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.93
|
|
|
PR NERVE GRAFT HEAD/NECK < 4 CM
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 64885
|
| Min. Negotiated Rate |
$886.60 |
| Max. Negotiated Rate |
$1,589.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,095.88
|
| Rate for Payer: AlohaCare Medicare |
$931.02
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Devoted Health Medicare |
$1,024.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$931.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$886.60
|
| Rate for Payer: Health Management Network Commercial |
$1,589.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,117.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,117.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,117.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,095.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$931.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,095.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$931.02
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$1,585.00
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$825.24 |
| Max. Negotiated Rate |
$1,347.25 |
| Rate for Payer: AlohaCare Medicaid |
$926.22
|
| Rate for Payer: AlohaCare Medicare |
$835.53
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Devoted Health Medicare |
$919.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$835.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$825.24
|
| Rate for Payer: Health Management Network Commercial |
$1,347.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,002.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,002.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,002.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$926.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$835.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$926.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$835.53
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 95937 TC
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$115.32
|
| Rate for Payer: AlohaCare Medicare |
$82.22
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Devoted Health Medicare |
$90.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.05
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.22
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 95937 26
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: AlohaCare Medicaid |
$115.32
|
| Rate for Payer: AlohaCare Medicare |
$35.29
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Devoted Health Medicare |
$38.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.05
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.29
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: AlohaCare Medicaid |
$115.32
|
| Rate for Payer: AlohaCare Medicare |
$117.52
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$129.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.05
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.52
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$196.82 |
| Max. Negotiated Rate |
$798.15 |
| Rate for Payer: AlohaCare Medicaid |
$545.97
|
| Rate for Payer: AlohaCare Medicare |
$507.37
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Devoted Health Medicare |
$558.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$196.82
|
| Rate for Payer: Health Management Network Commercial |
$798.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$545.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$545.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.37
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$319.18 |
| Max. Negotiated Rate |
$499.80 |
| Rate for Payer: AlohaCare Medicaid |
$342.33
|
| Rate for Payer: AlohaCare Medicare |
$319.18
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Devoted Health Medicare |
$351.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$319.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$367.64
|
| Rate for Payer: Health Management Network Commercial |
$499.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$383.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$383.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$383.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$319.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$319.18
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$495.82 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: AlohaCare Medicaid |
$639.16
|
| Rate for Payer: AlohaCare Medicare |
$594.91
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Devoted Health Medicare |
$654.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$594.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.82
|
| Rate for Payer: Health Management Network Commercial |
$935.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$713.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$713.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$713.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$639.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$594.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$639.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$594.91
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$432.93
|
| Rate for Payer: AlohaCare Medicare |
$400.83
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$440.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$432.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.83
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$889.21
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$755.83 |
| Rate for Payer: AlohaCare Medicaid |
$466.95
|
| Rate for Payer: AlohaCare Medicare |
$440.52
|
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Devoted Health Medicare |
$484.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$466.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$466.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$371.28
|
| Rate for Payer: Health Management Network Commercial |
$755.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$528.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.52
|
| Rate for Payer: University Health Alliance Commercial |
$582.41
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: AlohaCare Medicaid |
$105.64
|
| Rate for Payer: AlohaCare Medicare |
$99.01
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Devoted Health Medicare |
$108.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.11
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.01
|
| Rate for Payer: University Health Alliance Commercial |
$126.05
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$178.38
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$151.62 |
| Rate for Payer: AlohaCare Medicaid |
$75.74
|
| Rate for Payer: AlohaCare Medicare |
$70.79
|
| Rate for Payer: Cash Price |
$107.03
|
| Rate for Payer: Cash Price |
$107.03
|
| Rate for Payer: Devoted Health Medicare |
$77.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.79
|
| Rate for Payer: University Health Alliance Commercial |
$93.57
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$483.67 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: AlohaCare Medicaid |
$539.98
|
| Rate for Payer: AlohaCare Medicare |
$483.67
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Devoted Health Medicare |
$532.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$580.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$580.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$580.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$539.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$539.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.67
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$1,403.00
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$593.58 |
| Max. Negotiated Rate |
$1,192.55 |
| Rate for Payer: AlohaCare Medicaid |
$819.25
|
| Rate for Payer: AlohaCare Medicare |
$748.29
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Devoted Health Medicare |
$823.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$748.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$1,192.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$897.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$819.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$748.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$819.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$748.29
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$1,652.88
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,404.95 |
| Rate for Payer: AlohaCare Medicaid |
$697.58
|
| Rate for Payer: AlohaCare Medicare |
$628.53
|
| Rate for Payer: Cash Price |
$991.73
|
| Rate for Payer: Cash Price |
$991.73
|
| Rate for Payer: Devoted Health Medicare |
$691.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$697.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,077.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$628.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$697.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network Commercial |
$1,404.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$754.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$754.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$697.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$697.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.53
|
| Rate for Payer: University Health Alliance Commercial |
$796.98
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$506.66
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$430.66 |
| Rate for Payer: AlohaCare Medicaid |
$114.03
|
| Rate for Payer: AlohaCare Medicare |
$101.54
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Devoted Health Medicare |
$111.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.90
|
| Rate for Payer: Health Management Network Commercial |
$430.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.54
|
| Rate for Payer: University Health Alliance Commercial |
$141.68
|
|
|
PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS
|
Professional
|
Both
|
$778.78
|
|
|
Service Code
|
HCPCS 47531
|
| Min. Negotiated Rate |
$61.84 |
| Max. Negotiated Rate |
$661.96 |
| Rate for Payer: AlohaCare Medicaid |
$69.80
|
| Rate for Payer: AlohaCare Medicare |
$61.84
|
| Rate for Payer: Cash Price |
$467.27
|
| Rate for Payer: Cash Price |
$467.27
|
| Rate for Payer: Devoted Health Medicare |
$68.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.92
|
| Rate for Payer: Health Management Network Commercial |
$661.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.84
|
| Rate for Payer: University Health Alliance Commercial |
$87.08
|
|
