|
PR ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY
|
Professional
|
Both
|
$5,146.72
|
|
|
Service Code
|
HCPCS 50592
|
| Min. Negotiated Rate |
$296.27 |
| Max. Negotiated Rate |
$4,374.71 |
| Rate for Payer: AlohaCare Medicaid |
$338.40
|
| Rate for Payer: AlohaCare Medicare |
$296.27
|
| Rate for Payer: Cash Price |
$3,088.03
|
| Rate for Payer: Cash Price |
$3,088.03
|
| Rate for Payer: Devoted Health Medicare |
$325.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$338.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$570.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$338.40
|
| Rate for Payer: Health Management Network Commercial |
$4,374.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$338.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$338.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.27
|
| Rate for Payer: University Health Alliance Commercial |
$449.21
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN LXTR/PERPH NERVE
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 0441T
|
| Min. Negotiated Rate |
$3,356.65 |
| Max. Negotiated Rate |
$3,356.65 |
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Health Management Network Commercial |
$3,356.65
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN NRV PLEX/TRNCL NRV
|
Professional
|
Both
|
$13,626.00
|
|
|
Service Code
|
HCPCS 0442T
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$11,582.10 |
| Rate for Payer: Cash Price |
$8,175.60
|
| Rate for Payer: Cash Price |
$8,175.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.20
|
| Rate for Payer: Health Management Network Commercial |
$11,582.10
|
|
|
PR ABLTJ PERC CRYOABLTJ IMG GDN UXTR/PERPH NERVE
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 0440T
|
| Min. Negotiated Rate |
$3,356.65 |
| Max. Negotiated Rate |
$3,356.65 |
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Health Management Network Commercial |
$3,356.65
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$528.55
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$449.27 |
| Rate for Payer: AlohaCare Medicaid |
$217.89
|
| Rate for Payer: AlohaCare Medicare |
$193.80
|
| Rate for Payer: Cash Price |
$317.13
|
| Rate for Payer: Cash Price |
$317.13
|
| Rate for Payer: Devoted Health Medicare |
$213.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$217.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$346.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$217.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.24
|
| Rate for Payer: Health Management Network Commercial |
$449.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.80
|
| Rate for Payer: University Health Alliance Commercial |
$265.35
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$421.87
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$358.59 |
| Rate for Payer: AlohaCare Medicaid |
$166.96
|
| Rate for Payer: AlohaCare Medicare |
$151.44
|
| Rate for Payer: Cash Price |
$253.12
|
| Rate for Payer: Cash Price |
$253.12
|
| Rate for Payer: Devoted Health Medicare |
$166.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$166.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$166.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.58
|
| Rate for Payer: Health Management Network Commercial |
$358.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.44
|
| Rate for Payer: University Health Alliance Commercial |
$202.03
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$1,937.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$948.48 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,129.23
|
| Rate for Payer: AlohaCare Medicare |
$1,015.32
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Devoted Health Medicare |
$1,116.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,015.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.48
|
| Rate for Payer: Health Management Network Commercial |
$1,646.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,218.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,218.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,218.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,129.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,015.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,129.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,015.32
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$215.56
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$183.23 |
| Rate for Payer: AlohaCare Medicaid |
$52.81
|
| Rate for Payer: AlohaCare Medicare |
$42.67
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Devoted Health Medicare |
$46.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.88
|
| Rate for Payer: Health Management Network Commercial |
$183.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.67
|
|
|
PR ACOUSTIC REFLEX THRESHOLD
|
Professional
|
Both
|
$27.93
|
|
|
Service Code
|
HCPCS 92568
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: AlohaCare Medicaid |
$15.19
|
| Rate for Payer: AlohaCare Medicare |
$12.92
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Devoted Health Medicare |
$14.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.29
|
| Rate for Payer: Health Management Network Commercial |
$23.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.92
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$597.22 |
| Max. Negotiated Rate |
$953.70 |
| Rate for Payer: AlohaCare Medicaid |
$652.83
|
| Rate for Payer: AlohaCare Medicare |
$607.49
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Devoted Health Medicare |
$668.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$607.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$597.22
|
| Rate for Payer: Health Management Network Commercial |
$953.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$728.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$728.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$652.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$607.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$652.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$607.49
|
|
|
PR ACUPUNCTURE 1/> NDLS W/ESTIM 1ST 15 MIN
|
Professional
|
Both
|
$104.76
|
|
|
Service Code
|
HCPCS 97813
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: AlohaCare Medicare |
$33.66
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Cash Price |
$62.86
|
| Rate for Payer: Devoted Health Medicare |
$37.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.66
|
| Rate for Payer: Health Management Network Commercial |
$89.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.66
|
|
|
PR ACUPUNCTURE 1/> NDLS W/ESTIM EACH ADDL 15 MIN
|
Professional
|
Both
|
$52.41
|
|
|
Service Code
|
HCPCS 97814
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: AlohaCare Medicare |
$21.22
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Devoted Health Medicare |
$23.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.22
|
| Rate for Payer: Health Management Network Commercial |
$44.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.22
|
|
|
PR ACUPUNCTURE 1/> NDLS W/O ESTIM 1ST 15 MIN
|
Professional
|
Both
|
$89.51
|
|
|
Service Code
|
HCPCS 97810
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: AlohaCare Medicare |
$27.60
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Devoted Health Medicare |
$30.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.60
|
| Rate for Payer: Health Management Network Commercial |
$76.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.60
|
|
|
PR ACUPUNCTURE 1/> NDLS W/O ESTIM EACH ADDL 15 MIN
|
Professional
|
Both
|
$51.84
|
|
|
Service Code
|
HCPCS 97811
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: AlohaCare Medicare |
$20.88
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Devoted Health Medicare |
$22.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.88
|
| Rate for Payer: Health Management Network Commercial |
$44.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.88
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: AlohaCare Medicaid |
$227.45
|
| Rate for Payer: AlohaCare Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$223.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$182.00
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.28
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: AlohaCare Medicaid |
$247.88
|
| Rate for Payer: AlohaCare Medicare |
$221.92
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Devoted Health Medicare |
$244.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.48
|
| Rate for Payer: Health Management Network Commercial |
$360.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$247.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$247.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.92
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: AlohaCare Medicaid |
$260.34
|
| Rate for Payer: AlohaCare Medicare |
$230.18
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Devoted Health Medicare |
$253.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.12
|
| Rate for Payer: Health Management Network Commercial |
$379.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.18
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: AlohaCare Medicaid |
$213.12
|
| Rate for Payer: AlohaCare Medicare |
$191.35
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Devoted Health Medicare |
$210.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.70
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.35
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,242.59
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$380.90 |
| Max. Negotiated Rate |
$1,056.20 |
| Rate for Payer: AlohaCare Medicaid |
$527.45
|
| Rate for Payer: AlohaCare Medicare |
$480.29
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Devoted Health Medicare |
$528.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$527.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$865.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$527.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.90
|
| Rate for Payer: Health Management Network Commercial |
$1,056.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$576.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$576.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$576.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$527.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$527.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.29
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,584.98
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$406.38 |
| Max. Negotiated Rate |
$1,347.23 |
| Rate for Payer: AlohaCare Medicaid |
$676.10
|
| Rate for Payer: AlohaCare Medicare |
$614.79
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Devoted Health Medicare |
$676.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$676.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,117.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$614.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$676.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.38
|
| Rate for Payer: Health Management Network Commercial |
$1,347.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$737.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$737.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$737.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$676.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$614.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$676.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$614.79
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$2,063.11
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$779.02 |
| Max. Negotiated Rate |
$1,753.64 |
| Rate for Payer: AlohaCare Medicaid |
$893.48
|
| Rate for Payer: AlohaCare Medicare |
$779.02
|
| Rate for Payer: Cash Price |
$1,237.87
|
| Rate for Payer: Cash Price |
$1,237.87
|
| Rate for Payer: Devoted Health Medicare |
$856.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$893.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,479.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$893.48
|
| Rate for Payer: Health Management Network Commercial |
$1,753.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$934.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$934.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$934.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$893.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.02
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,715.94
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$669.89 |
| Max. Negotiated Rate |
$1,458.55 |
| Rate for Payer: AlohaCare Medicaid |
$793.63
|
| Rate for Payer: AlohaCare Medicare |
$669.89
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Cash Price |
$1,029.56
|
| Rate for Payer: Devoted Health Medicare |
$736.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$793.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,302.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$793.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$756.86
|
| Rate for Payer: Health Management Network Commercial |
$1,458.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$803.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$793.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.89
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,638.23
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$491.92 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: AlohaCare Medicaid |
$738.69
|
| Rate for Payer: AlohaCare Medicare |
$637.43
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Cash Price |
$982.94
|
| Rate for Payer: Devoted Health Medicare |
$701.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$738.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,214.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$738.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$491.92
|
| Rate for Payer: Health Management Network Commercial |
$1,392.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$764.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$764.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$738.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$738.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.43
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,852.15
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$673.40 |
| Max. Negotiated Rate |
$1,574.33 |
| Rate for Payer: AlohaCare Medicaid |
$853.08
|
| Rate for Payer: AlohaCare Medicare |
$718.48
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Cash Price |
$1,111.29
|
| Rate for Payer: Devoted Health Medicare |
$790.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$853.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,400.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$718.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$853.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$673.40
|
| Rate for Payer: Health Management Network Commercial |
$1,574.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$862.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$862.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$853.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$718.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$853.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$718.48
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$391.28
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$332.59 |
| Rate for Payer: AlohaCare Medicaid |
$212.97
|
| Rate for Payer: AlohaCare Medicare |
$178.78
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Cash Price |
$234.77
|
| Rate for Payer: Devoted Health Medicare |
$196.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.78
|
| Rate for Payer: Health Management Network Commercial |
$332.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.78
|
|
