|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$507.78 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: AlohaCare Medicaid |
$581.65
|
| Rate for Payer: AlohaCare Medicare |
$540.08
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Devoted Health Medicare |
$594.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$540.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.78
|
| Rate for Payer: Health Management Network Commercial |
$844.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$648.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$648.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$581.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$540.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$581.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$540.08
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$403.67 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$434.96
|
| Rate for Payer: AlohaCare Medicare |
$403.67
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$444.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$403.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$413.40
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$484.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.67
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: AlohaCare Medicaid |
$644.14
|
| Rate for Payer: AlohaCare Medicare |
$580.47
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Devoted Health Medicare |
$638.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.90
|
| Rate for Payer: Health Management Network Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$696.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$696.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$696.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$644.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.47
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$640.12 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: AlohaCare Medicaid |
$765.70
|
| Rate for Payer: AlohaCare Medicare |
$698.89
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Devoted Health Medicare |
$768.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$698.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.12
|
| Rate for Payer: Health Management Network Commercial |
$1,107.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$838.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$838.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$838.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$698.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$698.89
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$551.98 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: AlohaCare Medicaid |
$707.95
|
| Rate for Payer: AlohaCare Medicare |
$650.84
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Devoted Health Medicare |
$715.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$650.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.98
|
| Rate for Payer: Health Management Network Commercial |
$1,028.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$781.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$781.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$707.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$650.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$707.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$650.84
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$556.66 |
| Max. Negotiated Rate |
$970.70 |
| Rate for Payer: AlohaCare Medicaid |
$661.88
|
| Rate for Payer: AlohaCare Medicare |
$616.69
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Devoted Health Medicare |
$678.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$616.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.66
|
| Rate for Payer: Health Management Network Commercial |
$970.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$740.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$740.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$616.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$616.69
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$537.57
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$456.93 |
| Rate for Payer: AlohaCare Medicaid |
$173.00
|
| Rate for Payer: AlohaCare Medicare |
$155.27
|
| Rate for Payer: Cash Price |
$322.54
|
| Rate for Payer: Cash Price |
$322.54
|
| Rate for Payer: Devoted Health Medicare |
$170.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$173.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$173.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.36
|
| Rate for Payer: Health Management Network Commercial |
$456.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.27
|
| Rate for Payer: University Health Alliance Commercial |
$228.04
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$550.41
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$499.04 |
| Rate for Payer: AlohaCare Medicaid |
$177.28
|
| Rate for Payer: AlohaCare Medicare |
$160.33
|
| Rate for Payer: Cash Price |
$330.25
|
| Rate for Payer: Cash Price |
$330.25
|
| Rate for Payer: Devoted Health Medicare |
$176.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$177.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$499.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$177.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$467.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$177.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.33
|
| Rate for Payer: University Health Alliance Commercial |
$234.58
|
|
|
PR ANKLE DISARTICULATION
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 27889
|
| Min. Negotiated Rate |
$554.58 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: AlohaCare Medicaid |
$634.31
|
| Rate for Payer: AlohaCare Medicare |
$588.08
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Devoted Health Medicare |
$646.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$588.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.58
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$705.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$705.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$634.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$588.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$634.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$588.08
|
|
|
PR ANN BREAST EXAM
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS S0613
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
|
|
PR ANNUAL GYNECOLOGICAL EXAMINA
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS S0610
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$64.63 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
|
|
PR ANNUAL GYNECOLOGICAL EXAMINA
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS S0612
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$64.63 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.63
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
|
|
PR ANOSCOPY ABLATION LESION
|
Professional
|
Both
|
$363.60
|
|
|
Service Code
|
HCPCS 46615
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$309.06 |
| Rate for Payer: AlohaCare Medicaid |
$92.10
|
| Rate for Payer: AlohaCare Medicare |
$84.73
|
| Rate for Payer: Cash Price |
$218.16
|
| Rate for Payer: Cash Price |
$218.16
|
| Rate for Payer: Devoted Health Medicare |
$93.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$309.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$92.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.73
|
| Rate for Payer: University Health Alliance Commercial |
$122.25
|
|
|
PR ANOSCOPY CONTROL BLEEDING
|
Professional
|
Both
|
$351.80
|
|
|
Service Code
|
HCPCS 46614
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: AlohaCare Medicaid |
$65.73
|
| Rate for Payer: AlohaCare Medicare |
$62.41
|
| Rate for Payer: Cash Price |
$211.08
|
| Rate for Payer: Cash Price |
$211.08
|
| Rate for Payer: Devoted Health Medicare |
$68.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$152.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.58
|
| Rate for Payer: Health Management Network Commercial |
$299.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.41
|
| Rate for Payer: University Health Alliance Commercial |
$87.24
|
|
|
PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$249.60
|
|
|
Service Code
|
HCPCS 46600
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: AlohaCare Medicaid |
$42.94
|
| Rate for Payer: AlohaCare Medicare |
$41.99
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Devoted Health Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.28
|
| Rate for Payer: Health Management Network Commercial |
$212.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.99
|
| Rate for Payer: University Health Alliance Commercial |
$55.80
|
|
|
PR ANOSCOPY W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$594.88
|
|
|
Service Code
|
HCPCS 46606
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$505.65 |
| Rate for Payer: AlohaCare Medicaid |
$76.38
|
| Rate for Payer: AlohaCare Medicare |
$71.81
|
| Rate for Payer: Cash Price |
$356.93
|
| Rate for Payer: Cash Price |
$356.93
|
| Rate for Payer: Devoted Health Medicare |
$78.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$94.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$76.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.66
|
| Rate for Payer: Health Management Network Commercial |
$505.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.81
|
| Rate for Payer: University Health Alliance Commercial |
$100.19
|
|
|
PR ANOSCOPY W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$620.41
|
|
|
Service Code
|
HCPCS 46608
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$527.35 |
| Rate for Payer: AlohaCare Medicaid |
$84.05
|
| Rate for Payer: AlohaCare Medicare |
$80.33
|
| Rate for Payer: Cash Price |
$372.25
|
| Rate for Payer: Cash Price |
$372.25
|
| Rate for Payer: Devoted Health Medicare |
$88.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$131.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$527.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.33
|
| Rate for Payer: University Health Alliance Commercial |
$111.20
|
|
|
PR ANOSCOPY W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$591.92
|
|
|
Service Code
|
HCPCS 46610
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$503.13 |
| Rate for Payer: AlohaCare Medicaid |
$80.75
|
| Rate for Payer: AlohaCare Medicare |
$76.58
|
| Rate for Payer: Cash Price |
$355.15
|
| Rate for Payer: Cash Price |
$355.15
|
| Rate for Payer: Devoted Health Medicare |
$84.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$80.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$125.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$80.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$503.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.58
|
| Rate for Payer: University Health Alliance Commercial |
$106.43
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 45990
|
| Min. Negotiated Rate |
$98.59 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: AlohaCare Medicaid |
$105.67
|
| Rate for Payer: AlohaCare Medicare |
$98.59
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$108.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.58
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.59
|
|
|
PR ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,008.58
|
|
|
Service Code
|
HCPCS 59425
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: AlohaCare Medicaid |
$417.21
|
| Rate for Payer: AlohaCare Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Devoted Health Medicare |
$405.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$417.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$368.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$417.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$857.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$441.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$417.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$417.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.21
|
|
|
PR ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,851.88
|
|
|
Service Code
|
HCPCS 59426
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$1,574.10 |
| Rate for Payer: AlohaCare Medicaid |
$765.67
|
| Rate for Payer: AlohaCare Medicare |
$675.03
|
| Rate for Payer: Cash Price |
$1,111.13
|
| Rate for Payer: Cash Price |
$1,111.13
|
| Rate for Payer: Devoted Health Medicare |
$742.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$765.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$675.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$765.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.20
|
| Rate for Payer: Health Management Network Commercial |
$1,574.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$675.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$675.03
|
|
|
PR APLIGRAF
|
Professional
|
Both
|
$253.21
|
|
|
Service Code
|
HCPCS Q4101
|
| Min. Negotiated Rate |
$144.69 |
| Max. Negotiated Rate |
$215.23 |
| Rate for Payer: AlohaCare Medicare |
$144.69
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Cash Price |
$151.93
|
| Rate for Payer: Devoted Health Medicare |
$159.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.69
|
| Rate for Payer: Health Management Network Commercial |
$215.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.69
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: AlohaCare Medicaid |
$80.61
|
| Rate for Payer: AlohaCare Medicare |
$71.54
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Devoted Health Medicare |
$78.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.76
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.54
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$1,258.85 |
| Rate for Payer: AlohaCare Medicaid |
$864.85
|
| Rate for Payer: AlohaCare Medicare |
$804.74
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Devoted Health Medicare |
$885.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$804.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.84
|
| Rate for Payer: Health Management Network Commercial |
$1,258.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$965.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$965.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$965.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$864.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$804.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$864.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$804.74
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$924.80 |
| Rate for Payer: AlohaCare Medicaid |
$635.28
|
| Rate for Payer: AlohaCare Medicare |
$592.56
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Devoted Health Medicare |
$651.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$592.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.20
|
| Rate for Payer: Health Management Network Commercial |
$924.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$711.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$711.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$635.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$592.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$635.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$592.56
|
|
