|
PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 92933
|
| Min. Negotiated Rate |
$525.13 |
| Max. Negotiated Rate |
$901.85 |
| Rate for Payer: AlohaCare Medicaid |
$621.84
|
| Rate for Payer: AlohaCare Medicare |
$525.13
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Devoted Health Medicare |
$577.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.13
|
| Rate for Payer: Health Management Network Commercial |
$901.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$630.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$630.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$630.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$621.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$621.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.13
|
|
|
PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: AlohaCare Medicaid |
$622.70
|
| Rate for Payer: AlohaCare Medicare |
$559.50
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Devoted Health Medicare |
$615.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$559.50
|
| Rate for Payer: Health Management Network Commercial |
$902.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$671.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$671.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$671.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$559.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$622.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$559.50
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$2,665.60
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$2,265.76 |
| Rate for Payer: AlohaCare Medicaid |
$267.18
|
| Rate for Payer: AlohaCare Medicare |
$240.73
|
| Rate for Payer: Cash Price |
$1,599.36
|
| Rate for Payer: Cash Price |
$1,599.36
|
| Rate for Payer: Devoted Health Medicare |
$264.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$267.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$421.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$267.18
|
| Rate for Payer: Health Management Network Commercial |
$2,265.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.73
|
| Rate for Payer: University Health Alliance Commercial |
$366.59
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,115.05
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$429.44 |
| Max. Negotiated Rate |
$947.79 |
| Rate for Payer: AlohaCare Medicaid |
$460.87
|
| Rate for Payer: AlohaCare Medicare |
$429.44
|
| Rate for Payer: Cash Price |
$669.03
|
| Rate for Payer: Cash Price |
$669.03
|
| Rate for Payer: Devoted Health Medicare |
$472.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$460.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$699.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$460.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network Commercial |
$947.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$515.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$515.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$515.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$460.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$460.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.44
|
| Rate for Payer: University Health Alliance Commercial |
$574.43
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$635.96 |
| Max. Negotiated Rate |
$1,370.20 |
| Rate for Payer: AlohaCare Medicaid |
$944.77
|
| Rate for Payer: AlohaCare Medicare |
$878.63
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Devoted Health Medicare |
$966.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$878.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$635.96
|
| Rate for Payer: Health Management Network Commercial |
$1,370.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,054.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,054.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,054.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$944.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$878.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$944.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$878.63
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$643.39 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$715.49
|
| Rate for Payer: AlohaCare Medicare |
$643.39
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$707.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$643.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$758.68
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$772.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$772.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$772.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$715.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$643.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$715.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$643.39
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$313.53
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: AlohaCare Medicaid |
$148.43
|
| Rate for Payer: AlohaCare Medicare |
$138.14
|
| Rate for Payer: Cash Price |
$188.12
|
| Rate for Payer: Cash Price |
$188.12
|
| Rate for Payer: Devoted Health Medicare |
$151.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.43
|
| Rate for Payer: Health Management Network Commercial |
$266.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.14
|
| Rate for Payer: University Health Alliance Commercial |
$179.86
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$363.23
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: AlohaCare Medicaid |
$170.34
|
| Rate for Payer: AlohaCare Medicare |
$158.95
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Devoted Health Medicare |
$174.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$170.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$170.34
|
| Rate for Payer: Health Management Network Commercial |
$308.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.95
|
| Rate for Payer: University Health Alliance Commercial |
$205.90
|
|
|
PR PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 90885
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$196.80
|
|
|
Service Code
|
HCPCS 90845
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$167.28 |
| Rate for Payer: AlohaCare Medicaid |
$87.16
|
| Rate for Payer: AlohaCare Medicare |
$88.53
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Cash Price |
$118.08
|
| Rate for Payer: Devoted Health Medicare |
$97.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.16
|
| Rate for Payer: Health Management Network Commercial |
$167.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.53
|
| Rate for Payer: University Health Alliance Commercial |
$100.92
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$156.10
|
|
|
Service Code
|
HCPCS 96131
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: AlohaCare Medicaid |
$75.36
|
| Rate for Payer: AlohaCare Medicare |
$70.60
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Devoted Health Medicare |
$77.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.07
|
| Rate for Payer: Health Management Network Commercial |
$132.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.60
|
| Rate for Payer: University Health Alliance Commercial |
$94.30
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR
|
Professional
|
Both
|
$223.12
|
|
|
Service Code
|
HCPCS 96130
|
| Min. Negotiated Rate |
$99.78 |
| Max. Negotiated Rate |
$189.65 |
| Rate for Payer: AlohaCare Medicaid |
$109.26
|
| Rate for Payer: AlohaCare Medicare |
$99.78
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Devoted Health Medicare |
$109.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$109.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.00
|
| Rate for Payer: Health Management Network Commercial |
$189.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.78
|
| Rate for Payer: University Health Alliance Commercial |
$129.26
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
Both
|
$26.60
|
|
|
Service Code
|
HCPCS 90785
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: AlohaCare Medicaid |
$13.08
|
| Rate for Payer: AlohaCare Medicare |
$11.78
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Devoted Health Medicare |
$12.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Health Management Network Commercial |
$22.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.78
|
| Rate for Payer: University Health Alliance Commercial |
$14.19
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$139.18
|
|
|
Service Code
|
HCPCS 90840
|
| Min. Negotiated Rate |
$62.82 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: AlohaCare Medicaid |
$64.85
|
| Rate for Payer: AlohaCare Medicare |
$62.82
|
| Rate for Payer: Cash Price |
$83.51
|
| Rate for Payer: Cash Price |
$83.51
|
| Rate for Payer: Devoted Health Medicare |
$69.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.85
|
| Rate for Payer: Health Management Network Commercial |
$118.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.82
|
| Rate for Payer: University Health Alliance Commercial |
$74.62
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$289.36
|
|
|
Service Code
|
HCPCS 90839
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: AlohaCare Medicaid |
$129.79
|
| Rate for Payer: AlohaCare Medicare |
$130.41
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Devoted Health Medicare |
$143.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.79
|
| Rate for Payer: Health Management Network Commercial |
$245.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.41
|
| Rate for Payer: University Health Alliance Commercial |
$149.05
|
|
|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$154.94
|
|
|
Service Code
|
HCPCS 90832
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$131.70 |
| Rate for Payer: AlohaCare Medicaid |
$68.60
|
| Rate for Payer: AlohaCare Medicare |
$69.93
|
| Rate for Payer: Cash Price |
$92.96
|
| Rate for Payer: Cash Price |
$92.96
|
| Rate for Payer: Devoted Health Medicare |
$76.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.60
|
| Rate for Payer: Health Management Network Commercial |
$131.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.93
|
| Rate for Payer: University Health Alliance Commercial |
$80.22
|
|
|
PR PSYCHOTHERAPY W/PATIENT 45 MINUTES
|
Professional
|
Both
|
$205.47
|
|
|
Service Code
|
HCPCS 90834
|
| Min. Negotiated Rate |
$90.82 |
| Max. Negotiated Rate |
$174.65 |
| Rate for Payer: AlohaCare Medicaid |
$90.82
|
| Rate for Payer: AlohaCare Medicare |
$92.35
|
| Rate for Payer: Cash Price |
$123.28
|
| Rate for Payer: Cash Price |
$123.28
|
| Rate for Payer: Devoted Health Medicare |
$101.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.82
|
| Rate for Payer: Health Management Network Commercial |
$174.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.35
|
| Rate for Payer: University Health Alliance Commercial |
$105.43
|
|
|
PR PSYCHOTHERAPY W/PATIENT 60 MINUTES
|
Professional
|
Both
|
$301.37
|
|
|
Service Code
|
HCPCS 90837
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$256.16 |
| Rate for Payer: AlohaCare Medicaid |
$134.02
|
| Rate for Payer: AlohaCare Medicare |
$136.14
|
| Rate for Payer: Cash Price |
$180.82
|
| Rate for Payer: Cash Price |
$180.82
|
| Rate for Payer: Devoted Health Medicare |
$149.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.02
|
| Rate for Payer: Health Management Network Commercial |
$256.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.14
|
| Rate for Payer: University Health Alliance Commercial |
$155.93
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN
|
Professional
|
Both
|
$146.18
|
|
|
Service Code
|
HCPCS 90833
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$124.25 |
| Rate for Payer: AlohaCare Medicaid |
$64.28
|
| Rate for Payer: AlohaCare Medicare |
$65.68
|
| Rate for Payer: Cash Price |
$87.71
|
| Rate for Payer: Cash Price |
$87.71
|
| Rate for Payer: Devoted Health Medicare |
$72.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$64.28
|
| Rate for Payer: Health Management Network Commercial |
$124.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.68
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN
|
Professional
|
Both
|
$185.38
|
|
|
Service Code
|
HCPCS 90836
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$157.57 |
| Rate for Payer: AlohaCare Medicaid |
$81.51
|
| Rate for Payer: AlohaCare Medicare |
$83.14
|
| Rate for Payer: Cash Price |
$111.23
|
| Rate for Payer: Cash Price |
$111.23
|
| Rate for Payer: Devoted Health Medicare |
$91.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.51
|
| Rate for Payer: Health Management Network Commercial |
$157.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.14
|
| Rate for Payer: University Health Alliance Commercial |
$94.85
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 90838
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: AlohaCare Medicaid |
$108.01
|
| Rate for Payer: AlohaCare Medicare |
$110.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Devoted Health Medicare |
$121.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.01
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.00
|
| Rate for Payer: University Health Alliance Commercial |
$129.10
|
|
|
PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT
|
Professional
|
Both
|
$4.32
|
|
|
Service Code
|
HCPCS 96146
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: AlohaCare Medicaid |
$2.48
|
| Rate for Payer: AlohaCare Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.28
|
| Rate for Payer: Health Management Network Commercial |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.47
|
|
|
PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN
|
Professional
|
Both
|
$70.09
|
|
|
Service Code
|
HCPCS 96137
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: AlohaCare Medicaid |
$17.79
|
| Rate for Payer: AlohaCare Medicare |
$16.50
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Devoted Health Medicare |
$18.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.01
|
| Rate for Payer: Health Management Network Commercial |
$59.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.50
|
| Rate for Payer: University Health Alliance Commercial |
$21.95
|
|
|
PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN
|
Professional
|
Both
|
$70.46
|
|
|
Service Code
|
HCPCS 96139
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: AlohaCare Medicaid |
$40.35
|
| Rate for Payer: AlohaCare Medicare |
$40.26
|
| Rate for Payer: Cash Price |
$42.28
|
| Rate for Payer: Cash Price |
$42.28
|
| Rate for Payer: Devoted Health Medicare |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.42
|
| Rate for Payer: Health Management Network Commercial |
$59.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.26
|
|
|
PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 96136
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: AlohaCare Medicaid |
$23.27
|
| Rate for Payer: AlohaCare Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$23.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.49
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.42
|
| Rate for Payer: University Health Alliance Commercial |
$28.43
|
|
