|
PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$5.98
|
|
|
Service Code
|
HCPCS 96160
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: AlohaCare Medicaid |
$3.44
|
| Rate for Payer: AlohaCare Medicare |
$3.42
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Devoted Health Medicare |
$3.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.38
|
| Rate for Payer: Health Management Network Commercial |
$5.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.42
|
|
|
PR PT HAS CLINICAL SYMP&SIGNS NEUROPATHY W/CAUSE
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 3753F
|
| Min. Negotiated Rate |
$994.50 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Health Management Network Commercial |
$994.50
|
|
|
PR PT HAS PSEUDOBULBAR AFFECT/SIALORRHEA/ALS SYMP
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 3756F
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
|
|
PR PT NOT RCVNG CORTICOSTERIDS>=10MG/DAY 60/> DAYS
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 3750F
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 94618 26
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$23.30
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Devoted Health Medicare |
$25.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.94
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.30
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 94618
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$39.44
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Devoted Health Medicare |
$43.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.94
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.44
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94618 TC
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: AlohaCare Medicaid |
$36.04
|
| Rate for Payer: AlohaCare Medicare |
$16.14
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$17.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.94
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.14
|
|
|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$114.48
|
|
|
Service Code
|
HCPCS 11105
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: AlohaCare Medicaid |
$25.66
|
| Rate for Payer: AlohaCare Medicare |
$20.99
|
| Rate for Payer: Cash Price |
$68.69
|
| Rate for Payer: Cash Price |
$68.69
|
| Rate for Payer: Devoted Health Medicare |
$23.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.86
|
| Rate for Payer: Health Management Network Commercial |
$97.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.99
|
| Rate for Payer: University Health Alliance Commercial |
$29.74
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$231.82
|
|
|
Service Code
|
HCPCS 11104
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$197.05 |
| Rate for Payer: AlohaCare Medicaid |
$47.09
|
| Rate for Payer: AlohaCare Medicare |
$37.91
|
| Rate for Payer: Cash Price |
$139.09
|
| Rate for Payer: Cash Price |
$139.09
|
| Rate for Payer: Devoted Health Medicare |
$41.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.84
|
| Rate for Payer: Health Management Network Commercial |
$197.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.91
|
| Rate for Payer: University Health Alliance Commercial |
$54.29
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$246.86
|
|
|
Service Code
|
HCPCS 10160
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$209.83 |
| Rate for Payer: AlohaCare Medicaid |
$101.97
|
| Rate for Payer: AlohaCare Medicare |
$95.49
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Devoted Health Medicare |
$105.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$153.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$209.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.49
|
| Rate for Payer: University Health Alliance Commercial |
$110.81
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$181.25
|
|
|
Service Code
|
HCPCS 19000
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$154.06 |
| Rate for Payer: AlohaCare Medicaid |
$41.49
|
| Rate for Payer: AlohaCare Medicare |
$35.59
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Devoted Health Medicare |
$39.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$65.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$154.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.59
|
| Rate for Payer: University Health Alliance Commercial |
$48.80
|
|
|
PR PURAPLY AM 1 SQ CM
|
Professional
|
Both
|
$253.21
|
|
|
Service Code
|
HCPCS Q4196
|
| Min. Negotiated Rate |
$144.69 |
| Max. Negotiated Rate |
$215.23 |
| Rate for Payer: AlohaCare Medicare |
$144.69
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Devoted Health Medicare |
$159.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.69
|
| Rate for Payer: Health Management Network Commercial |
$215.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.69
|
|
|
PR PURE TONE AUDIOMETRY AIR & BONE
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 92553
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$52.59
|
| Rate for Payer: AlohaCare Medicare |
$55.64
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$61.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.41
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.64
|
|
|
PR PURE TONE AUDIOMETRY AIR ONLY
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 92552
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: AlohaCare Medicaid |
$43.41
|
| Rate for Payer: AlohaCare Medicare |
$45.77
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.92
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.77
|
|
|
PR PYELOPLASTY COMPLICATED
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 50405
|
| Min. Negotiated Rate |
$1,170.78 |
| Max. Negotiated Rate |
$2,031.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,394.47
|
| Rate for Payer: AlohaCare Medicare |
$1,238.13
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Devoted Health Medicare |
$1,361.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,238.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,170.78
|
| Rate for Payer: Health Management Network Commercial |
$2,031.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,485.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,485.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,394.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,238.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,394.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,238.13
|
|
|
PR PYELOPLASTY SIMPLE
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 50400
|
| Min. Negotiated Rate |
$936.52 |
| Max. Negotiated Rate |
$1,685.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,157.41
|
| Rate for Payer: AlohaCare Medicare |
$1,029.96
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Devoted Health Medicare |
$1,132.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,029.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$936.52
|
| Rate for Payer: Health Management Network Commercial |
$1,685.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,235.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,235.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,235.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,157.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,029.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,157.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,029.96
|
|
|
PR PYLOROPLASTY
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 43800
|
| Min. Negotiated Rate |
$511.16 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: AlohaCare Medicaid |
$916.34
|
| Rate for Payer: AlohaCare Medicare |
$851.91
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Devoted Health Medicare |
$937.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$851.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$511.16
|
| Rate for Payer: Health Management Network Commercial |
$1,333.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,022.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,022.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$916.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$851.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$916.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$851.91
|
|
|
PR RADIESSE INJECTION
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS Q2026
|
| Min. Negotiated Rate |
$495.55 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Health Management Network Commercial |
$495.55
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>
|
Professional
|
Both
|
$2,275.00
|
|
|
Service Code
|
HCPCS 22905
|
| Min. Negotiated Rate |
$1,220.74 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,322.29
|
| Rate for Payer: AlohaCare Medicare |
$1,220.74
|
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Devoted Health Medicare |
$1,342.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,220.74
|
| Rate for Payer: Health Management Network Commercial |
$1,933.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,464.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,464.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,464.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,322.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,220.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,322.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,220.74
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 21935
|
| Min. Negotiated Rate |
$738.14 |
| Max. Negotiated Rate |
$1,488.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,026.47
|
| Rate for Payer: AlohaCare Medicare |
$949.47
|
| Rate for Payer: Cash Price |
$1,050.60
|
| Rate for Payer: Cash Price |
$1,050.60
|
| Rate for Payer: Devoted Health Medicare |
$1,044.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.14
|
| Rate for Payer: Health Management Network Commercial |
$1,488.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,026.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,026.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.47
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$1,329.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$710.18 |
| Max. Negotiated Rate |
$1,129.65 |
| Rate for Payer: AlohaCare Medicaid |
$771.90
|
| Rate for Payer: AlohaCare Medicare |
$710.18
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Devoted Health Medicare |
$781.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$710.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$815.10
|
| Rate for Payer: Health Management Network Commercial |
$1,129.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$852.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$852.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$852.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$771.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$771.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.18
|
|
|
PR RCNSTJ MIDFACE LEFORT III W/O LEFORT I
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 21154
|
| Min. Negotiated Rate |
$1,680.28 |
| Max. Negotiated Rate |
$2,873.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,986.90
|
| Rate for Payer: AlohaCare Medicare |
$1,680.28
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: Devoted Health Medicare |
$1,848.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,680.28
|
| Rate for Payer: Health Management Network Commercial |
$2,873.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,016.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,016.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,016.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,986.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,680.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,680.28
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$371.19
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$315.51 |
| Rate for Payer: AlohaCare Medicaid |
$215.84
|
| Rate for Payer: AlohaCare Medicare |
$212.31
|
| Rate for Payer: Cash Price |
$222.71
|
| Rate for Payer: Cash Price |
$222.71
|
| Rate for Payer: Devoted Health Medicare |
$233.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.76
|
| Rate for Payer: Health Management Network Commercial |
$315.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$215.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.31
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$334.88 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: AlohaCare Medicaid |
$464.64
|
| Rate for Payer: AlohaCare Medicare |
$422.35
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Devoted Health Medicare |
$464.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$422.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$334.88
|
| Rate for Payer: Health Management Network Commercial |
$676.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$506.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$464.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$422.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$464.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$422.35
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$563.94 |
| Max. Negotiated Rate |
$1,345.55 |
| Rate for Payer: AlohaCare Medicaid |
$923.77
|
| Rate for Payer: AlohaCare Medicare |
$860.85
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Devoted Health Medicare |
$946.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$860.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$563.94
|
| Rate for Payer: Health Management Network Commercial |
$1,345.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,033.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,033.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,033.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$923.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$860.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$923.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$860.85
|
|
