|
PR THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 32667
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: UnitedHealthcare Medicare |
$134.01
|
| Rate for Payer: AlohaCare Medicaid |
$146.19
|
| Rate for Payer: AlohaCare Medicare |
$134.01
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Devoted Health Medicare |
$147.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.01
|
| Rate for Payer: Health Management Network Commercial |
$211.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$146.19
|
|
|
PR THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 32666
|
| Min. Negotiated Rate |
$822.92 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: AlohaCare Medicaid |
$845.95
|
| Rate for Payer: AlohaCare Medicare |
$822.92
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Devoted Health Medicare |
$905.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$822.92
|
| Rate for Payer: Health Management Network Commercial |
$1,230.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$987.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$987.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$987.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$845.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$822.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$845.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$822.92
|
|
|
PR THORACOTOMY W/CARDIAC MASSAGE
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 32160
|
| Min. Negotiated Rate |
$569.92 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: AlohaCare Medicaid |
$783.13
|
| Rate for Payer: AlohaCare Medicare |
$761.81
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Devoted Health Medicare |
$837.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$761.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$569.92
|
| Rate for Payer: Health Management Network Commercial |
$1,146.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$914.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$914.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$914.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$783.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$761.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$783.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$761.81
|
|
|
PR THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR
|
Professional
|
Both
|
$2,458.00
|
|
|
Service Code
|
HCPCS 32110
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,432.01
|
| Rate for Payer: AlohaCare Medicare |
$1,360.56
|
| Rate for Payer: Cash Price |
$1,474.80
|
| Rate for Payer: Cash Price |
$1,474.80
|
| Rate for Payer: Devoted Health Medicare |
$1,496.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,360.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$780.00
|
| Rate for Payer: Health Management Network Commercial |
$2,089.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,632.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,632.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,632.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,432.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,360.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,432.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,360.56
|
|
|
PR THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 32601
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: AlohaCare Medicaid |
$294.55
|
| Rate for Payer: AlohaCare Medicare |
$278.80
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Devoted Health Medicare |
$306.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$359.06
|
| Rate for Payer: Health Management Network Commercial |
$428.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$334.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$334.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$294.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$294.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.80
|
|
|
PR THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 35875
|
| Min. Negotiated Rate |
$515.16 |
| Max. Negotiated Rate |
$808.35 |
| Rate for Payer: AlohaCare Medicaid |
$559.32
|
| Rate for Payer: AlohaCare Medicare |
$515.16
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Devoted Health Medicare |
$566.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$515.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$541.32
|
| Rate for Payer: Health Management Network Commercial |
$808.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$618.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$618.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$618.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$559.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$515.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$559.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$515.16
|
|
|
PR THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
HCPCS 35876
|
| Min. Negotiated Rate |
$741.26 |
| Max. Negotiated Rate |
$1,278.40 |
| Rate for Payer: AlohaCare Medicaid |
$881.89
|
| Rate for Payer: AlohaCare Medicare |
$813.54
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Devoted Health Medicare |
$894.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$813.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.26
|
| Rate for Payer: Health Management Network Commercial |
$1,278.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$976.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$976.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$881.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$813.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$881.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$813.54
|
|
|
PR THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 34490
|
| Min. Negotiated Rate |
$440.44 |
| Max. Negotiated Rate |
$783.70 |
| Rate for Payer: AlohaCare Medicaid |
$539.99
|
| Rate for Payer: AlohaCare Medicare |
$500.65
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Devoted Health Medicare |
$550.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$500.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$440.44
|
| Rate for Payer: Health Management Network Commercial |
$783.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$600.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$600.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$600.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$539.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$500.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$539.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$500.65
|
|
|
PR THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 34421
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: AlohaCare Medicaid |
$649.52
|
| Rate for Payer: AlohaCare Medicare |
$600.77
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Devoted Health Medicare |
$660.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$600.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$513.50
|
| Rate for Payer: Health Management Network Commercial |
$943.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$720.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$720.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$720.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$649.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$600.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$649.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$600.77
|
|
|
PR THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF
|
Professional
|
Both
|
$1,001.00
|
|
|
Service Code
|
HCPCS 36831
|
| Min. Negotiated Rate |
$310.44 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: AlohaCare Medicaid |
$585.81
|
| Rate for Payer: AlohaCare Medicare |
$542.97
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Devoted Health Medicare |
$597.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$542.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.44
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$651.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$651.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$651.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$585.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$542.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$585.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$542.97
|
|
|
PR THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 37211
|
| Min. Negotiated Rate |
$322.15 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: AlohaCare Medicaid |
$364.22
|
| Rate for Payer: AlohaCare Medicare |
$322.15
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Devoted Health Medicare |
$354.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$322.15
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$386.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.15
|
| Rate for Payer: University Health Alliance Commercial |
$495.00
|
|
|
PR THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 37213
|
| Min. Negotiated Rate |
$193.11 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: AlohaCare Medicaid |
$217.61
|
| Rate for Payer: AlohaCare Medicare |
$193.11
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Devoted Health Medicare |
$212.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.11
|
| Rate for Payer: Health Management Network Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$231.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$231.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$217.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.11
|
| Rate for Payer: University Health Alliance Commercial |
$350.00
|
|
|
PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 37212
|
| Min. Negotiated Rate |
$282.02 |
| Max. Negotiated Rate |
$464.95 |
| Rate for Payer: AlohaCare Medicaid |
$319.10
|
| Rate for Payer: AlohaCare Medicare |
$282.02
|
| Rate for Payer: Cash Price |
$328.20
|
| Rate for Payer: Cash Price |
$328.20
|
| Rate for Payer: Devoted Health Medicare |
$310.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.02
|
| Rate for Payer: Health Management Network Commercial |
$464.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$338.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$319.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$319.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.02
|
|
|
PR THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 60260
|
| Min. Negotiated Rate |
$732.42 |
| Max. Negotiated Rate |
$1,585.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,091.82
|
| Rate for Payer: AlohaCare Medicare |
$956.72
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Devoted Health Medicare |
$1,052.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$956.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$732.42
|
| Rate for Payer: Health Management Network Commercial |
$1,585.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,148.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,148.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,148.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,091.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$956.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,091.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$956.72
|
|
|
PR THYROIDECTOMY TOTAL/COMPLETE
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 60240
|
| Min. Negotiated Rate |
$819.79 |
| Max. Negotiated Rate |
$1,338.75 |
| Rate for Payer: AlohaCare Medicaid |
$920.95
|
| Rate for Payer: AlohaCare Medicare |
$819.79
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Devoted Health Medicare |
$901.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$819.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,032.46
|
| Rate for Payer: Health Management Network Commercial |
$1,338.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$983.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$983.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$819.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$920.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$819.79
|
|
|
PR THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 60252
|
| Min. Negotiated Rate |
$941.46 |
| Max. Negotiated Rate |
$1,918.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,321.62
|
| Rate for Payer: AlohaCare Medicare |
$1,162.42
|
| Rate for Payer: Cash Price |
$1,354.20
|
| Rate for Payer: Cash Price |
$1,354.20
|
| Rate for Payer: Devoted Health Medicare |
$1,278.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,162.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$941.46
|
| Rate for Payer: Health Management Network Commercial |
$1,918.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,394.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,394.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,321.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,162.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,321.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,162.42
|
|
|
PR THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC
|
Professional
|
Both
|
$2,312.00
|
|
|
Service Code
|
HCPCS 60270
|
| Min. Negotiated Rate |
$943.54 |
| Max. Negotiated Rate |
$1,965.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,356.88
|
| Rate for Payer: AlohaCare Medicare |
$1,206.25
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Devoted Health Medicare |
$1,326.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,206.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$943.54
|
| Rate for Payer: Health Management Network Commercial |
$1,965.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,447.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,447.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,447.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,356.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,206.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,356.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,206.25
|
|
|
PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$2,077.00
|
|
|
Service Code
|
HCPCS 19357
|
| Min. Negotiated Rate |
$906.62 |
| Max. Negotiated Rate |
$1,765.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,207.00
|
| Rate for Payer: AlohaCare Medicare |
$1,102.91
|
| Rate for Payer: Cash Price |
$1,246.20
|
| Rate for Payer: Cash Price |
$1,246.20
|
| Rate for Payer: Devoted Health Medicare |
$1,213.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,102.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$906.62
|
| Rate for Payer: Health Management Network Commercial |
$1,765.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,323.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,323.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,323.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,207.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,102.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,207.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,102.91
|
|
|
PR TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP
|
Professional
|
Both
|
$2,366.00
|
|
|
Service Code
|
HCPCS 69637
|
| Min. Negotiated Rate |
$947.44 |
| Max. Negotiated Rate |
$2,011.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,494.79
|
| Rate for Payer: AlohaCare Medicare |
$1,351.59
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Devoted Health Medicare |
$1,486.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,351.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$947.44
|
| Rate for Payer: Health Management Network Commercial |
$2,011.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,621.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,621.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,621.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,494.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,351.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,494.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,351.59
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 69643
|
| Min. Negotiated Rate |
$964.60 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,288.24
|
| Rate for Payer: AlohaCare Medicare |
$1,124.66
|
| Rate for Payer: Cash Price |
$1,181.40
|
| Rate for Payer: Cash Price |
$1,181.40
|
| Rate for Payer: Devoted Health Medicare |
$1,237.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,124.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$964.60
|
| Rate for Payer: Health Management Network Commercial |
$1,673.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,349.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,349.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,349.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,288.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,124.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,288.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,124.66
|
|
|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$799.50 |
| Max. Negotiated Rate |
$1,579.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,101.58
|
| Rate for Payer: AlohaCare Medicare |
$963.38
|
| Rate for Payer: Cash Price |
$1,114.80
|
| Rate for Payer: Cash Price |
$1,114.80
|
| Rate for Payer: Devoted Health Medicare |
$1,059.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$963.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$799.50
|
| Rate for Payer: Health Management Network Commercial |
$1,579.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,156.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,156.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,156.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,101.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$963.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,101.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$963.38
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,378.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$1,045.98 |
| Max. Negotiated Rate |
$2,021.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,409.74
|
| Rate for Payer: AlohaCare Medicare |
$1,225.65
|
| Rate for Payer: Cash Price |
$1,426.80
|
| Rate for Payer: Cash Price |
$1,426.80
|
| Rate for Payer: Devoted Health Medicare |
$1,348.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,225.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,045.98
|
| Rate for Payer: Health Management Network Commercial |
$2,021.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,470.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,470.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,470.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,409.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,225.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,409.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,225.65
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$52.52
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$44.64 |
| Rate for Payer: AlohaCare Medicaid |
$25.04
|
| Rate for Payer: AlohaCare Medicare |
$22.03
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Devoted Health Medicare |
$24.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.54
|
| Rate for Payer: Health Management Network Commercial |
$44.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.03
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: AlohaCare Medicaid |
$11.80
|
| Rate for Payer: AlohaCare Medicare |
$10.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Devoted Health Medicare |
$11.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.50
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.68
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: AlohaCare Medicaid |
$39.58
|
| Rate for Payer: AlohaCare Medicare |
$40.45
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$44.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.41
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.45
|
|
