|
PR CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS
|
Professional
|
Both
|
$822.73
|
|
|
Service Code
|
HCPCS 52007
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$699.32 |
| Rate for Payer: AlohaCare Medicaid |
$165.56
|
| Rate for Payer: AlohaCare Medicare |
$147.33
|
| Rate for Payer: Cash Price |
$493.64
|
| Rate for Payer: Cash Price |
$493.64
|
| Rate for Payer: Devoted Health Medicare |
$162.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$254.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.76
|
| Rate for Payer: Health Management Network Commercial |
$699.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.33
|
| Rate for Payer: University Health Alliance Commercial |
$215.86
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$264.15 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: AlohaCare Medicaid |
$299.13
|
| Rate for Payer: AlohaCare Medicare |
$264.15
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$290.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$329.94
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.15
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$386.66 |
| Max. Negotiated Rate |
$640.05 |
| Rate for Payer: AlohaCare Medicaid |
$439.27
|
| Rate for Payer: AlohaCare Medicare |
$386.66
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Devoted Health Medicare |
$425.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$386.66
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$463.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$463.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$386.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$439.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$386.66
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$321.11 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: AlohaCare Medicaid |
$364.52
|
| Rate for Payer: AlohaCare Medicare |
$321.11
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Devoted Health Medicare |
$353.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.11
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.11
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$342.44 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: AlohaCare Medicaid |
$388.78
|
| Rate for Payer: AlohaCare Medicare |
$342.44
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Devoted Health Medicare |
$376.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$416.26
|
| Rate for Payer: Health Management Network Commercial |
$566.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$410.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$388.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$388.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.44
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$111.28
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$94.59 |
| Rate for Payer: AlohaCare Medicaid |
$27.41
|
| Rate for Payer: AlohaCare Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$66.77
|
| Rate for Payer: Cash Price |
$66.77
|
| Rate for Payer: Devoted Health Medicare |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$94.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.09
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$50.54
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: AlohaCare Medicaid |
$14.75
|
| Rate for Payer: AlohaCare Medicare |
$12.55
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Devoted Health Medicare |
$13.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.84
|
| Rate for Payer: Health Management Network Commercial |
$42.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.55
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,269.70
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$356.79 |
| Max. Negotiated Rate |
$1,079.24 |
| Rate for Payer: AlohaCare Medicaid |
$413.97
|
| Rate for Payer: AlohaCare Medicare |
$356.79
|
| Rate for Payer: Cash Price |
$761.82
|
| Rate for Payer: Cash Price |
$761.82
|
| Rate for Payer: Devoted Health Medicare |
$392.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$413.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$646.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$413.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$520.26
|
| Rate for Payer: Health Management Network Commercial |
$1,079.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$413.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.79
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$486.13 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: AlohaCare Medicaid |
$549.81
|
| Rate for Payer: AlohaCare Medicare |
$486.13
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Devoted Health Medicare |
$534.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$486.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$535.60
|
| Rate for Payer: Health Management Network Commercial |
$799.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$583.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$583.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$486.13
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,075.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$791.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.83
|
| Rate for Payer: University Health Alliance Commercial |
$1,026.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$598.41 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: AlohaCare Medicaid |
$673.84
|
| Rate for Payer: AlohaCare Medicare |
$598.41
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Devoted Health Medicare |
$658.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$598.41
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$718.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$673.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$673.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$598.41
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$876.54
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$250.99 |
| Max. Negotiated Rate |
$745.06 |
| Rate for Payer: AlohaCare Medicaid |
$280.66
|
| Rate for Payer: AlohaCare Medicare |
$250.99
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Devoted Health Medicare |
$276.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$280.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$280.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.36
|
| Rate for Payer: Health Management Network Commercial |
$745.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.99
|
| Rate for Payer: University Health Alliance Commercial |
$321.89
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,000.07
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$850.06 |
| Rate for Payer: AlohaCare Medicaid |
$296.15
|
| Rate for Payer: AlohaCare Medicare |
$261.39
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Devoted Health Medicare |
$287.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$296.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$460.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$296.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.10
|
| Rate for Payer: Health Management Network Commercial |
$850.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.39
|
| Rate for Payer: University Health Alliance Commercial |
$500.00
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$922.90 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,029.44
|
| Rate for Payer: AlohaCare Medicare |
$922.90
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Devoted Health Medicare |
$1,015.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.90
|
| Rate for Payer: Health Management Network Commercial |
$1,501.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,029.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,029.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.90
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$437.32 |
| Max. Negotiated Rate |
$1,007.25 |
| Rate for Payer: AlohaCare Medicaid |
$689.07
|
| Rate for Payer: AlohaCare Medicare |
$638.56
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Devoted Health Medicare |
$702.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.32
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.56
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$1,128.93 |
| Max. Negotiated Rate |
$1,831.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,255.28
|
| Rate for Payer: AlohaCare Medicare |
$1,128.93
|
| Rate for Payer: Cash Price |
$1,293.00
|
| Rate for Payer: Cash Price |
$1,293.00
|
| Rate for Payer: Devoted Health Medicare |
$1,241.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,128.93
|
| Rate for Payer: Health Management Network Commercial |
$1,831.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,354.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,354.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,354.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,255.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,128.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,255.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,128.93
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,356.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$1,152.60 |
| Rate for Payer: AlohaCare Medicaid |
$803.97
|
| Rate for Payer: AlohaCare Medicare |
$772.39
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Devoted Health Medicare |
$849.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$772.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$451.36
|
| Rate for Payer: Health Management Network Commercial |
$1,152.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$926.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$926.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$926.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$772.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$803.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$772.39
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: AlohaCare Medicaid |
$407.08
|
| Rate for Payer: AlohaCare Medicare |
$377.59
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Devoted Health Medicare |
$415.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$377.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.58
|
| Rate for Payer: Health Management Network Commercial |
$595.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$453.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$453.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$453.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$407.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$377.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$407.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$377.59
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$682.55 |
| Rate for Payer: AlohaCare Medicaid |
$470.98
|
| Rate for Payer: AlohaCare Medicare |
$434.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Devoted Health Medicare |
$478.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$457.34
|
| Rate for Payer: Health Management Network Commercial |
$682.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$521.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$521.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$470.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$470.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.80
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$1,421.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,207.85 |
| Rate for Payer: AlohaCare Medicaid |
$821.17
|
| Rate for Payer: AlohaCare Medicare |
$752.42
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Devoted Health Medicare |
$827.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$752.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.00
|
| Rate for Payer: Health Management Network Commercial |
$1,207.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$902.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$902.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$902.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$821.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$752.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$821.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$752.42
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$549.29
|
| Rate for Payer: AlohaCare Medicare |
$523.22
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$575.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$523.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.80
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$523.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$523.22
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$282.36 |
| Max. Negotiated Rate |
$663.85 |
| Rate for Payer: AlohaCare Medicaid |
$459.40
|
| Rate for Payer: AlohaCare Medicare |
$427.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Devoted Health Medicare |
$470.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$427.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$282.36
|
| Rate for Payer: Health Management Network Commercial |
$663.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$513.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$513.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$427.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$459.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$427.60
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$585.11
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$198.39 |
| Max. Negotiated Rate |
$497.34 |
| Rate for Payer: AlohaCare Medicaid |
$223.77
|
| Rate for Payer: AlohaCare Medicare |
$198.39
|
| Rate for Payer: Cash Price |
$351.07
|
| Rate for Payer: Cash Price |
$351.07
|
| Rate for Payer: Devoted Health Medicare |
$218.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$223.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$429.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$223.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.52
|
| Rate for Payer: Health Management Network Commercial |
$497.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.39
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$230.35
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: AlohaCare Medicaid |
$94.37
|
| Rate for Payer: AlohaCare Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Devoted Health Medicare |
$90.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.37
|
| Rate for Payer: Health Management Network Commercial |
$195.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.26
|
| Rate for Payer: University Health Alliance Commercial |
$109.82
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$413.18
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$351.20 |
| Rate for Payer: AlohaCare Medicaid |
$147.04
|
| Rate for Payer: AlohaCare Medicare |
$132.81
|
| Rate for Payer: Cash Price |
$247.91
|
| Rate for Payer: Cash Price |
$247.91
|
| Rate for Payer: Devoted Health Medicare |
$146.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$225.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$147.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$351.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.81
|
|
