|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$445.64 |
| Max. Negotiated Rate |
$770.10 |
| Rate for Payer: AlohaCare Medicaid |
$525.74
|
| Rate for Payer: AlohaCare Medicare |
$485.75
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Devoted Health Medicare |
$534.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$485.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.64
|
| Rate for Payer: Health Management Network Commercial |
$770.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$582.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$582.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$485.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$485.75
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$373.62 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: AlohaCare Medicaid |
$590.82
|
| Rate for Payer: AlohaCare Medicare |
$549.40
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Devoted Health Medicare |
$604.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$549.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.62
|
| Rate for Payer: Health Management Network Commercial |
$862.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$659.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$659.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$549.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$590.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$549.40
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$279.24 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: AlohaCare Medicaid |
$392.17
|
| Rate for Payer: AlohaCare Medicare |
$360.38
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Devoted Health Medicare |
$396.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$360.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.24
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$392.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$360.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$392.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$360.38
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$475.54 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: AlohaCare Medicaid |
$535.89
|
| Rate for Payer: AlohaCare Medicare |
$491.18
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Devoted Health Medicare |
$540.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$491.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.54
|
| Rate for Payer: Health Management Network Commercial |
$784.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$589.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$589.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$535.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$491.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$535.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$491.18
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$404.99 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: AlohaCare Medicaid |
$466.65
|
| Rate for Payer: AlohaCare Medicare |
$404.99
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Devoted Health Medicare |
$445.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$404.99
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$485.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$485.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$485.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$404.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$466.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.99
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AlohaCare Medicaid |
$304.21
|
| Rate for Payer: AlohaCare Medicare |
$269.72
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$296.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.72
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$304.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$304.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.72
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$210.96
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: AlohaCare Medicaid |
$58.38
|
| Rate for Payer: AlohaCare Medicare |
$51.05
|
| Rate for Payer: Cash Price |
$126.58
|
| Rate for Payer: Cash Price |
$126.58
|
| Rate for Payer: Devoted Health Medicare |
$56.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.38
|
| Rate for Payer: Health Management Network Commercial |
$179.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.05
|
| Rate for Payer: University Health Alliance Commercial |
$72.75
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$2,183.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$1,855.55 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Health Management Network Commercial |
$1,855.55
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$927.35 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,721.58
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$291.70 |
| Max. Negotiated Rate |
$2,313.34 |
| Rate for Payer: AlohaCare Medicaid |
$329.95
|
| Rate for Payer: AlohaCare Medicare |
$291.70
|
| Rate for Payer: Cash Price |
$1,632.95
|
| Rate for Payer: Cash Price |
$1,632.95
|
| Rate for Payer: Devoted Health Medicare |
$320.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$329.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$525.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$329.95
|
| Rate for Payer: Health Management Network Commercial |
$2,313.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$350.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$350.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$329.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$329.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.70
|
| Rate for Payer: University Health Alliance Commercial |
$526.00
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.96
|
| Rate for Payer: Health Management Network Commercial |
$226.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.39
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$493.74 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: AlohaCare Medicaid |
$813.42
|
| Rate for Payer: AlohaCare Medicare |
$726.35
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Devoted Health Medicare |
$798.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$493.74
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$871.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$871.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$813.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$813.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.35
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$694.54 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: AlohaCare Medicaid |
$775.77
|
| Rate for Payer: AlohaCare Medicare |
$694.54
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Devoted Health Medicare |
$763.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$694.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network Commercial |
$1,122.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$833.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$833.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$833.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$775.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$694.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$775.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$694.54
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: AlohaCare Medicaid |
$119.20
|
| Rate for Payer: AlohaCare Medicare |
$107.19
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Devoted Health Medicare |
$117.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.28
|
| Rate for Payer: Health Management Network Commercial |
$172.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.19
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: AlohaCare Medicaid |
$79.26
|
| Rate for Payer: AlohaCare Medicare |
$70.62
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Devoted Health Medicare |
$77.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.57
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.62
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$44.06
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Devoted Health Medicare |
$48.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.28
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.06
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$295.71
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$251.35 |
| Rate for Payer: AlohaCare Medicaid |
$157.37
|
| Rate for Payer: AlohaCare Medicare |
$142.78
|
| Rate for Payer: Cash Price |
$177.43
|
| Rate for Payer: Cash Price |
$177.43
|
| Rate for Payer: Devoted Health Medicare |
$157.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.74
|
| Rate for Payer: Health Management Network Commercial |
$251.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$171.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$157.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$157.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.78
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$143.83
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$50.97 |
| Max. Negotiated Rate |
$122.26 |
| Rate for Payer: AlohaCare Medicaid |
$76.70
|
| Rate for Payer: AlohaCare Medicare |
$69.65
|
| Rate for Payer: Cash Price |
$86.30
|
| Rate for Payer: Cash Price |
$86.30
|
| Rate for Payer: Devoted Health Medicare |
$76.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.97
|
| Rate for Payer: Health Management Network Commercial |
$122.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.65
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$208.02
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$176.82 |
| Rate for Payer: AlohaCare Medicaid |
$110.71
|
| Rate for Payer: AlohaCare Medicare |
$100.64
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Devoted Health Medicare |
$110.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.47
|
| Rate for Payer: Health Management Network Commercial |
$176.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.64
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$76.51
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$65.03 |
| Rate for Payer: AlohaCare Medicaid |
$41.45
|
| Rate for Payer: AlohaCare Medicare |
$38.02
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Cash Price |
$45.91
|
| Rate for Payer: Devoted Health Medicare |
$41.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.59
|
| Rate for Payer: Health Management Network Commercial |
$65.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.02
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,374.38
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$2,018.22 |
| Rate for Payer: AlohaCare Medicaid |
$116.54
|
| Rate for Payer: AlohaCare Medicare |
$103.56
|
| Rate for Payer: Cash Price |
$1,424.63
|
| Rate for Payer: Cash Price |
$1,424.63
|
| Rate for Payer: Devoted Health Medicare |
$113.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$182.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,133.60
|
| Rate for Payer: Health Management Network Commercial |
$2,018.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.56
|
| Rate for Payer: University Health Alliance Commercial |
$162.04
|
|
|
PR SCREENING FOR DEPRESSION PERFORMED
|
Professional
|
Both
|
$16,595.00
|
|
|
Service Code
|
HCPCS 3725F
|
| Min. Negotiated Rate |
$14,105.75 |
| Max. Negotiated Rate |
$14,105.75 |
| Rate for Payer: Cash Price |
$9,957.00
|
| Rate for Payer: Health Management Network Commercial |
$14,105.75
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: AlohaCare Medicaid |
$14.34
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.38
|
| Rate for Payer: Health Management Network Commercial |
$20.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.34
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.20
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
|
