|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,123.86 |
| Max. Negotiated Rate |
$1,827.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,252.17
|
| Rate for Payer: AlohaCare Medicare |
$1,123.86
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Devoted Health Medicare |
$1,236.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,123.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,266.20
|
| Rate for Payer: Health Management Network Commercial |
$1,827.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,348.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,348.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,348.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,252.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,123.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,252.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,123.86
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$772.61
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$656.72 |
| Rate for Payer: AlohaCare Medicaid |
$397.39
|
| Rate for Payer: AlohaCare Medicare |
$349.96
|
| Rate for Payer: Cash Price |
$463.57
|
| Rate for Payer: Cash Price |
$463.57
|
| Rate for Payer: Devoted Health Medicare |
$384.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$397.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$410.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$397.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.36
|
| Rate for Payer: Health Management Network Commercial |
$656.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$419.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$419.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$397.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$397.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.96
|
| Rate for Payer: University Health Alliance Commercial |
$521.02
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$759.76
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$645.80 |
| Rate for Payer: AlohaCare Medicaid |
$384.06
|
| Rate for Payer: AlohaCare Medicare |
$338.83
|
| Rate for Payer: Cash Price |
$455.86
|
| Rate for Payer: Cash Price |
$455.86
|
| Rate for Payer: Devoted Health Medicare |
$372.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$384.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$397.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$384.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.60
|
| Rate for Payer: Health Management Network Commercial |
$645.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$406.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$406.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$384.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.83
|
| Rate for Payer: University Health Alliance Commercial |
$505.16
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$667.16 |
| Max. Negotiated Rate |
$1,390.60 |
| Rate for Payer: AlohaCare Medicaid |
$952.29
|
| Rate for Payer: AlohaCare Medicare |
$866.50
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Devoted Health Medicare |
$953.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$866.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$667.16
|
| Rate for Payer: Health Management Network Commercial |
$1,390.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,039.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,039.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,039.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$952.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$866.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$952.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$866.50
|
|
|
PR TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV
|
Professional
|
Both
|
$140.79
|
|
|
Service Code
|
HCPCS 92507
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$119.67 |
| Rate for Payer: AlohaCare Medicaid |
$80.55
|
| Rate for Payer: AlohaCare Medicare |
$80.45
|
| Rate for Payer: Cash Price |
$84.47
|
| Rate for Payer: Cash Price |
$84.47
|
| Rate for Payer: Devoted Health Medicare |
$88.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.04
|
| Rate for Payer: Health Management Network Commercial |
$119.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.45
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$595.19
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$505.91 |
| Rate for Payer: AlohaCare Medicaid |
$195.02
|
| Rate for Payer: AlohaCare Medicare |
$183.26
|
| Rate for Payer: Cash Price |
$357.11
|
| Rate for Payer: Cash Price |
$357.11
|
| Rate for Payer: Devoted Health Medicare |
$201.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$321.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.44
|
| Rate for Payer: Health Management Network Commercial |
$505.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.26
|
| Rate for Payer: University Health Alliance Commercial |
$212.61
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$344.02
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$292.42 |
| Rate for Payer: AlohaCare Medicaid |
$147.11
|
| Rate for Payer: AlohaCare Medicare |
$138.48
|
| Rate for Payer: Cash Price |
$206.41
|
| Rate for Payer: Cash Price |
$206.41
|
| Rate for Payer: Devoted Health Medicare |
$152.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$242.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$147.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.78
|
| Rate for Payer: Health Management Network Commercial |
$292.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.48
|
| Rate for Payer: University Health Alliance Commercial |
$166.98
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$435.58
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$370.24 |
| Rate for Payer: AlohaCare Medicaid |
$211.84
|
| Rate for Payer: AlohaCare Medicare |
$206.75
|
| Rate for Payer: Cash Price |
$261.35
|
| Rate for Payer: Cash Price |
$261.35
|
| Rate for Payer: Devoted Health Medicare |
$227.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$211.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.04
|
| Rate for Payer: Health Management Network Commercial |
$370.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.75
|
| Rate for Payer: University Health Alliance Commercial |
$308.00
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$1,758.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$924.15 |
| Max. Negotiated Rate |
$1,494.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,023.18
|
| Rate for Payer: AlohaCare Medicare |
$924.15
|
| Rate for Payer: Cash Price |
$1,054.80
|
| Rate for Payer: Cash Price |
$1,054.80
|
| Rate for Payer: Devoted Health Medicare |
$1,016.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$924.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,085.76
|
| Rate for Payer: Health Management Network Commercial |
$1,494.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,108.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,108.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,108.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,023.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$924.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,023.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$924.15
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$705.83
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$252.18 |
| Max. Negotiated Rate |
$599.96 |
| Rate for Payer: AlohaCare Medicaid |
$296.52
|
| Rate for Payer: AlohaCare Medicare |
$252.18
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Devoted Health Medicare |
$277.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$296.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$491.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$252.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$296.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.54
|
| Rate for Payer: Health Management Network Commercial |
$599.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$302.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$296.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.18
|
| Rate for Payer: University Health Alliance Commercial |
$387.20
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$29.98
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$25.48 |
| Rate for Payer: AlohaCare Medicaid |
$11.05
|
| Rate for Payer: AlohaCare Medicare |
$8.77
|
| Rate for Payer: Cash Price |
$17.99
|
| Rate for Payer: Cash Price |
$17.99
|
| Rate for Payer: Devoted Health Medicare |
$9.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.91
|
| Rate for Payer: Health Management Network Commercial |
$25.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.77
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$40.08
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$34.07 |
| Rate for Payer: AlohaCare Medicaid |
$22.93
|
| Rate for Payer: AlohaCare Medicare |
$22.90
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$25.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.51
|
| Rate for Payer: Health Management Network Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.90
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,885.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$982.89 |
| Max. Negotiated Rate |
$1,602.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,117.46
|
| Rate for Payer: AlohaCare Medicare |
$982.89
|
| Rate for Payer: Cash Price |
$1,131.00
|
| Rate for Payer: Cash Price |
$1,131.00
|
| Rate for Payer: Devoted Health Medicare |
$1,081.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$982.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.90
|
| Rate for Payer: Health Management Network Commercial |
$1,602.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,179.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,179.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,179.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,117.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$982.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,117.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$982.89
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$1,598.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$824.72 |
| Max. Negotiated Rate |
$1,358.30 |
| Rate for Payer: AlohaCare Medicaid |
$949.46
|
| Rate for Payer: AlohaCare Medicare |
$837.10
|
| Rate for Payer: Cash Price |
$958.80
|
| Rate for Payer: Cash Price |
$958.80
|
| Rate for Payer: Devoted Health Medicare |
$920.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$837.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$824.72
|
| Rate for Payer: Health Management Network Commercial |
$1,358.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,004.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,004.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$949.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$837.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$949.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$837.10
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$150.25 |
| Max. Negotiated Rate |
$245.65 |
| Rate for Payer: AlohaCare Medicaid |
$169.47
|
| Rate for Payer: AlohaCare Medicare |
$150.25
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Devoted Health Medicare |
$165.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.08
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.25
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$383.64
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$326.09 |
| Rate for Payer: AlohaCare Medicaid |
$141.47
|
| Rate for Payer: AlohaCare Medicare |
$125.04
|
| Rate for Payer: Cash Price |
$230.18
|
| Rate for Payer: Cash Price |
$230.18
|
| Rate for Payer: Devoted Health Medicare |
$137.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.48
|
| Rate for Payer: Health Management Network Commercial |
$326.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.04
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,934.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$1,008.65 |
| Max. Negotiated Rate |
$1,643.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,146.76
|
| Rate for Payer: AlohaCare Medicare |
$1,008.65
|
| Rate for Payer: Cash Price |
$1,160.40
|
| Rate for Payer: Cash Price |
$1,160.40
|
| Rate for Payer: Devoted Health Medicare |
$1,109.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,008.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,053.00
|
| Rate for Payer: Health Management Network Commercial |
$1,643.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,210.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,210.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,210.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,146.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,008.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,146.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,008.65
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,308.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$1,002.82 |
| Max. Negotiated Rate |
$1,961.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,360.24
|
| Rate for Payer: AlohaCare Medicare |
$1,233.47
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Devoted Health Medicare |
$1,356.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,233.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,002.82
|
| Rate for Payer: Health Management Network Commercial |
$1,961.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,480.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,480.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,480.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,360.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,233.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,360.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,233.47
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$878.90 |
| Rate for Payer: AlohaCare Medicaid |
$601.33
|
| Rate for Payer: AlohaCare Medicare |
$566.67
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Devoted Health Medicare |
$623.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$878.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$680.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$680.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$680.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$601.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.67
|
|
|
PR UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 93799
|
| Min. Negotiated Rate |
$238.85 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Health Management Network Commercial |
$238.85
|
|
|
PR UNLISTED HYSTEROSCOPY PROCEDURE UTERUS
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 58579
|
| Min. Negotiated Rate |
$629.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Management Network Commercial |
$629.00
|
|
|
PR UNLISTED LAPAROSCOPIC PROCEDURE LIVER
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 47379
|
| Min. Negotiated Rate |
$1,330.25 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Health Management Network Commercial |
$1,330.25
|
|
|
PR UNLISTED LAPAROSCOPY PROCEDURE BLADDER
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 51999
|
| Min. Negotiated Rate |
$1,294.55 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Health Management Network Commercial |
$1,294.55
|
|
|
PR UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT OVARY
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 58679
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$1,428.00 |
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
|
|
PR UNLISTED LAPAROSCOPY PROCEDURE RECTUM
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 45499
|
| Min. Negotiated Rate |
$1,925.25 |
| Max. Negotiated Rate |
$1,925.25 |
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Health Management Network Commercial |
$1,925.25
|
|
