|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$301.77
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: AlohaCare Medicaid |
$136.17
|
| Rate for Payer: AlohaCare Medicare |
$125.73
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Devoted Health Medicare |
$138.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.34
|
| Rate for Payer: Health Management Network Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.73
|
| Rate for Payer: University Health Alliance Commercial |
$169.47
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$261.78
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$270.79 |
| Rate for Payer: AlohaCare Medicaid |
$101.67
|
| Rate for Payer: AlohaCare Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$157.07
|
| Rate for Payer: Cash Price |
$157.07
|
| Rate for Payer: Devoted Health Medicare |
$94.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$270.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.82
|
| Rate for Payer: Health Management Network Commercial |
$222.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.17
|
| Rate for Payer: University Health Alliance Commercial |
$110.49
|
|
|
PR RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 50580
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: AlohaCare Medicaid |
$595.61
|
| Rate for Payer: AlohaCare Medicare |
$521.92
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Devoted Health Medicare |
$574.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$521.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$467.22
|
| Rate for Payer: Health Management Network Commercial |
$867.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$626.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$626.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$626.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$595.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$521.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$595.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$521.92
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$1,696.60 |
| Max. Negotiated Rate |
$1,696.60 |
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Management Network Commercial |
$1,696.60
|
|
|
PR RPLCMT CATH CTR VAD SUBQ PORT/PMP
|
Professional
|
Both
|
$821.71
|
|
|
Service Code
|
HCPCS 36578
|
| Min. Negotiated Rate |
$188.15 |
| Max. Negotiated Rate |
$1,017.12 |
| Rate for Payer: AlohaCare Medicaid |
$201.78
|
| Rate for Payer: AlohaCare Medicare |
$188.15
|
| Rate for Payer: Cash Price |
$493.03
|
| Rate for Payer: Cash Price |
$493.03
|
| Rate for Payer: Devoted Health Medicare |
$206.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$201.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$341.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$188.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$201.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,017.12
|
| Rate for Payer: Health Management Network Commercial |
$698.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$188.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$201.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$188.15
|
| Rate for Payer: University Health Alliance Commercial |
$268.63
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$1,641.27
|
|
|
Service Code
|
HCPCS 36582
|
| Min. Negotiated Rate |
$256.95 |
| Max. Negotiated Rate |
$1,395.08 |
| Rate for Payer: AlohaCare Medicaid |
$282.76
|
| Rate for Payer: AlohaCare Medicare |
$256.95
|
| Rate for Payer: Cash Price |
$984.76
|
| Rate for Payer: Cash Price |
$984.76
|
| Rate for Payer: Devoted Health Medicare |
$282.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$282.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$480.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$256.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$282.76
|
| Rate for Payer: Health Management Network Commercial |
$1,395.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$308.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$256.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$256.95
|
| Rate for Payer: University Health Alliance Commercial |
$378.63
|
|
|
PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,469.39
|
|
|
Service Code
|
HCPCS 36581
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$1,248.98 |
| Rate for Payer: AlohaCare Medicaid |
$181.53
|
| Rate for Payer: AlohaCare Medicare |
$164.80
|
| Rate for Payer: Cash Price |
$881.63
|
| Rate for Payer: Cash Price |
$881.63
|
| Rate for Payer: Devoted Health Medicare |
$181.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$307.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$181.53
|
| Rate for Payer: Health Management Network Commercial |
$1,248.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$197.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.80
|
| Rate for Payer: University Health Alliance Commercial |
$248.53
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$374.92 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: AlohaCare Medicaid |
$632.78
|
| Rate for Payer: AlohaCare Medicare |
$601.10
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Devoted Health Medicare |
$661.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$374.92
|
| Rate for Payer: Health Management Network Commercial |
$923.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$721.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$721.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$721.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$632.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.10
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$352.04 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: AlohaCare Medicaid |
$579.36
|
| Rate for Payer: AlohaCare Medicare |
$551.97
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Devoted Health Medicare |
$607.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$551.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.04
|
| Rate for Payer: Health Management Network Commercial |
$845.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$662.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$662.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$662.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$579.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$551.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$579.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$551.97
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: AlohaCare Medicaid |
$589.94
|
| Rate for Payer: AlohaCare Medicare |
$562.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Devoted Health Medicare |
$618.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$562.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$518.70
|
| Rate for Payer: Health Management Network Commercial |
$860.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$674.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$674.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$674.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$589.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$589.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.20
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$903.00
|
|
|
Service Code
|
HCPCS 49505
|
| Min. Negotiated Rate |
$424.58 |
| Max. Negotiated Rate |
$767.55 |
| Rate for Payer: AlohaCare Medicaid |
$526.25
|
| Rate for Payer: AlohaCare Medicare |
$503.91
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Devoted Health Medicare |
$554.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$503.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$424.58
|
| Rate for Payer: Health Management Network Commercial |
$767.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$604.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$604.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$604.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$526.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$503.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$526.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$503.91
|
|
|
PR RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 49596
|
| Min. Negotiated Rate |
$893.43 |
| Max. Negotiated Rate |
$1,443.30 |
| Rate for Payer: AlohaCare Medicaid |
$988.71
|
| Rate for Payer: AlohaCare Medicare |
$893.43
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Devoted Health Medicare |
$982.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.43
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,072.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,072.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,072.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$988.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$988.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.43
|
|
|
PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE
|
Professional
|
Both
|
$1,281.00
|
|
|
Service Code
|
HCPCS 49595
|
| Min. Negotiated Rate |
$674.07 |
| Max. Negotiated Rate |
$1,088.85 |
| Rate for Payer: AlohaCare Medicaid |
$745.70
|
| Rate for Payer: AlohaCare Medicare |
$674.07
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Devoted Health Medicare |
$741.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$674.07
|
| Rate for Payer: Health Management Network Commercial |
$1,088.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$808.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$808.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$745.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$674.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$745.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$674.07
|
|
|
PR RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 49594
|
| Min. Negotiated Rate |
$651.53 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: AlohaCare Medicaid |
$720.76
|
| Rate for Payer: AlohaCare Medicare |
$651.53
|
| Rate for Payer: Cash Price |
$740.40
|
| Rate for Payer: Cash Price |
$740.40
|
| Rate for Payer: Devoted Health Medicare |
$716.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$651.53
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$781.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$781.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$720.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$651.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$720.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$651.53
|
|
|
PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 49593
|
| Min. Negotiated Rate |
$502.59 |
| Max. Negotiated Rate |
$808.35 |
| Rate for Payer: AlohaCare Medicaid |
$554.95
|
| Rate for Payer: AlohaCare Medicare |
$502.59
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Devoted Health Medicare |
$552.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$502.59
|
| Rate for Payer: Health Management Network Commercial |
$808.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$603.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$603.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$603.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$554.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$502.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$554.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$502.59
|
|
|
PR RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 49592
|
| Min. Negotiated Rate |
$418.73 |
| Max. Negotiated Rate |
$671.50 |
| Rate for Payer: AlohaCare Medicaid |
$460.99
|
| Rate for Payer: AlohaCare Medicare |
$418.73
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Devoted Health Medicare |
$460.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$418.73
|
| Rate for Payer: Health Management Network Commercial |
$671.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$502.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$502.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$502.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$460.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$460.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.73
|
|
|
PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 49591
|
| Min. Negotiated Rate |
$304.52 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: AlohaCare Medicaid |
$333.31
|
| Rate for Payer: AlohaCare Medicare |
$304.52
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Devoted Health Medicare |
$334.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$304.52
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$365.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$365.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$365.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$333.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$304.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$333.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$304.52
|
|
|
PR RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 49618
|
| Min. Negotiated Rate |
$1,079.48 |
| Max. Negotiated Rate |
$1,748.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,197.34
|
| Rate for Payer: AlohaCare Medicare |
$1,079.48
|
| Rate for Payer: Cash Price |
$1,234.20
|
| Rate for Payer: Cash Price |
$1,234.20
|
| Rate for Payer: Devoted Health Medicare |
$1,187.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,079.48
|
| Rate for Payer: Health Management Network Commercial |
$1,748.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,295.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,295.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,295.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,197.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,079.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,197.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,079.48
|
|
|
PR RPR AA HERNIA RECR > 10 CM REDUCIBLE
|
Professional
|
Both
|
$1,473.00
|
|
|
Service Code
|
HCPCS 49617
|
| Min. Negotiated Rate |
$772.97 |
| Max. Negotiated Rate |
$1,252.05 |
| Rate for Payer: AlohaCare Medicaid |
$856.76
|
| Rate for Payer: AlohaCare Medicare |
$772.97
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Devoted Health Medicare |
$850.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$772.97
|
| Rate for Payer: Health Management Network Commercial |
$1,252.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$927.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$927.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$927.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$856.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$772.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$856.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$772.97
|
|
|
PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 49616
|
| Min. Negotiated Rate |
$747.57 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: AlohaCare Medicaid |
$829.51
|
| Rate for Payer: AlohaCare Medicare |
$747.57
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Devoted Health Medicare |
$822.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$747.57
|
| Rate for Payer: Health Management Network Commercial |
$1,207.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$897.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$829.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$747.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$829.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$747.57
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 49615
|
| Min. Negotiated Rate |
$558.49 |
| Max. Negotiated Rate |
$901.00 |
| Rate for Payer: AlohaCare Medicaid |
$619.06
|
| Rate for Payer: AlohaCare Medicare |
$558.49
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Devoted Health Medicare |
$614.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$558.49
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$670.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$670.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$670.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$619.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$558.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$619.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$558.49
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 49614
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: AlohaCare Medicaid |
$553.48
|
| Rate for Payer: AlohaCare Medicare |
$501.50
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Devoted Health Medicare |
$551.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$501.50
|
| Rate for Payer: Health Management Network Commercial |
$805.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$553.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$501.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$553.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$501.50
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 49613
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: AlohaCare Medicaid |
$410.64
|
| Rate for Payer: AlohaCare Medicare |
$372.40
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Devoted Health Medicare |
$409.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.40
|
| Rate for Payer: Health Management Network Commercial |
$596.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$446.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$446.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.40
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$657.94 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$720.79
|
| Rate for Payer: AlohaCare Medicare |
$657.94
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$723.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$657.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$681.20
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$789.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$789.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$720.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$657.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$720.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$657.94
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$1,382.82
|
|
|
Service Code
|
HCPCS 26350
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,175.40 |
| Rate for Payer: AlohaCare Medicaid |
$814.69
|
| Rate for Payer: AlohaCare Medicare |
$790.18
|
| Rate for Payer: Cash Price |
$829.69
|
| Rate for Payer: Cash Price |
$829.69
|
| Rate for Payer: Devoted Health Medicare |
$869.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$790.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.56
|
| Rate for Payer: Health Management Network Commercial |
$1,175.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$948.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$948.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$948.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$814.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$790.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$814.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$790.18
|
|
