|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,912.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,625.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,125.28
|
| Rate for Payer: AlohaCare Medicare |
$1,031.88
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Devoted Health Medicare |
$1,135.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,031.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$675.22
|
| Rate for Payer: Health Management Network Commercial |
$1,625.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,238.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,238.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,031.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,125.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,031.88
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,585.68
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$485.42 |
| Max. Negotiated Rate |
$1,347.83 |
| Rate for Payer: AlohaCare Medicaid |
$726.33
|
| Rate for Payer: AlohaCare Medicare |
$626.21
|
| Rate for Payer: Cash Price |
$951.41
|
| Rate for Payer: Cash Price |
$951.41
|
| Rate for Payer: Devoted Health Medicare |
$688.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$726.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,117.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$726.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$485.42
|
| Rate for Payer: Health Management Network Commercial |
$1,347.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$751.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$751.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$751.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$726.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$726.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.21
|
| Rate for Payer: University Health Alliance Commercial |
$826.66
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,374.96
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$456.04 |
| Max. Negotiated Rate |
$1,168.72 |
| Rate for Payer: AlohaCare Medicaid |
$601.44
|
| Rate for Payer: AlohaCare Medicare |
$522.89
|
| Rate for Payer: Cash Price |
$824.98
|
| Rate for Payer: Cash Price |
$824.98
|
| Rate for Payer: Devoted Health Medicare |
$575.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$601.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$917.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$601.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$456.04
|
| Rate for Payer: Health Management Network Commercial |
$1,168.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$601.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.89
|
| Rate for Payer: University Health Alliance Commercial |
$777.02
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,156.26
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$465.13 |
| Max. Negotiated Rate |
$982.82 |
| Rate for Payer: AlohaCare Medicaid |
$521.14
|
| Rate for Payer: AlohaCare Medicare |
$465.13
|
| Rate for Payer: Cash Price |
$693.76
|
| Rate for Payer: Cash Price |
$693.76
|
| Rate for Payer: Devoted Health Medicare |
$511.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$521.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$808.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$465.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$521.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$634.66
|
| Rate for Payer: Health Management Network Commercial |
$982.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$558.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$558.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$558.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$521.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$465.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$465.13
|
| Rate for Payer: University Health Alliance Commercial |
$598.47
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,226.58
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$485.57 |
| Max. Negotiated Rate |
$1,042.59 |
| Rate for Payer: AlohaCare Medicaid |
$532.69
|
| Rate for Payer: AlohaCare Medicare |
$485.57
|
| Rate for Payer: Cash Price |
$735.95
|
| Rate for Payer: Cash Price |
$735.95
|
| Rate for Payer: Devoted Health Medicare |
$534.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$532.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$790.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$485.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$532.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$628.94
|
| Rate for Payer: Health Management Network Commercial |
$1,042.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$582.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$582.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$532.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$485.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$532.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$485.57
|
| Rate for Payer: University Health Alliance Commercial |
$584.99
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$366.57
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$119.47 |
| Max. Negotiated Rate |
$311.58 |
| Rate for Payer: AlohaCare Medicaid |
$142.37
|
| Rate for Payer: AlohaCare Medicare |
$119.47
|
| Rate for Payer: Cash Price |
$219.94
|
| Rate for Payer: Cash Price |
$219.94
|
| Rate for Payer: Devoted Health Medicare |
$131.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$223.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.80
|
| Rate for Payer: Health Management Network Commercial |
$311.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.47
|
| Rate for Payer: University Health Alliance Commercial |
$165.42
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$375.18
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$318.90 |
| Rate for Payer: AlohaCare Medicaid |
$147.27
|
| Rate for Payer: AlohaCare Medicare |
$124.00
|
| Rate for Payer: Cash Price |
$225.11
|
| Rate for Payer: Cash Price |
$225.11
|
| Rate for Payer: Devoted Health Medicare |
$136.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$147.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$195.26
|
| Rate for Payer: Health Management Network Commercial |
$318.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.00
|
| Rate for Payer: University Health Alliance Commercial |
$169.87
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$462.29 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: AlohaCare Medicaid |
$496.03
|
| Rate for Payer: AlohaCare Medicare |
$462.29
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Devoted Health Medicare |
$508.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$518.44
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$554.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$554.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$554.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$496.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$496.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.29
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$54.79
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$46.57 |
| Rate for Payer: AlohaCare Medicaid |
$24.07
|
| Rate for Payer: AlohaCare Medicare |
$24.47
|
| Rate for Payer: Cash Price |
$32.87
|
| Rate for Payer: Cash Price |
$32.87
|
| Rate for Payer: Devoted Health Medicare |
$26.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.07
|
| Rate for Payer: Health Management Network Commercial |
$46.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.47
|
| Rate for Payer: University Health Alliance Commercial |
$29.44
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$1,232.66 |
| Max. Negotiated Rate |
$2,073.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,422.04
|
| Rate for Payer: AlohaCare Medicare |
$1,317.68
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Devoted Health Medicare |
$1,449.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,317.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,232.66
|
| Rate for Payer: Health Management Network Commercial |
$2,073.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,581.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,581.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,581.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,422.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,317.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,422.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,317.68
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,396.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$1,233.18 |
| Max. Negotiated Rate |
$2,886.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,982.14
|
| Rate for Payer: AlohaCare Medicare |
$1,813.11
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Devoted Health Medicare |
$1,994.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,813.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,233.18
|
| Rate for Payer: Health Management Network Commercial |
$2,886.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,175.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,175.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,175.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,982.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,813.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,982.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,813.11
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$953.68 |
| Max. Negotiated Rate |
$2,733.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,876.79
|
| Rate for Payer: AlohaCare Medicare |
$1,718.36
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Devoted Health Medicare |
$1,890.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,718.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$953.68
|
| Rate for Payer: Health Management Network Commercial |
$2,733.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,062.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,062.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,062.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,876.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,718.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,876.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,718.36
|
|
|
PR GSTRCT TOT W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,792.00
|
|
|
Service Code
|
HCPCS 43621
|
| Min. Negotiated Rate |
$1,125.54 |
| Max. Negotiated Rate |
$3,223.20 |
| Rate for Payer: AlohaCare Medicaid |
$2,209.83
|
| Rate for Payer: AlohaCare Medicare |
$2,019.48
|
| Rate for Payer: Cash Price |
$2,275.20
|
| Rate for Payer: Cash Price |
$2,275.20
|
| Rate for Payer: Devoted Health Medicare |
$2,221.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,019.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,125.54
|
| Rate for Payer: Health Management Network Commercial |
$3,223.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,423.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,423.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,423.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,209.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,019.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,209.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,019.48
|
|
|
PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 35572
|
| Min. Negotiated Rate |
$287.31 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: AlohaCare Medicaid |
$316.39
|
| Rate for Payer: AlohaCare Medicare |
$287.31
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Devoted Health Medicare |
$316.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.46
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$344.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$344.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.31
|
|
|
PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 35500
|
| Min. Negotiated Rate |
$268.04 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: AlohaCare Medicaid |
$292.07
|
| Rate for Payer: AlohaCare Medicare |
$268.04
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Devoted Health Medicare |
$294.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$335.14
|
| Rate for Payer: Health Management Network Commercial |
$423.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$292.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$292.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.04
|
|
|
PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Professional
|
Both
|
$194.13
|
|
|
Service Code
|
HCPCS 96156
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$165.01 |
| Rate for Payer: AlohaCare Medicaid |
$88.31
|
| Rate for Payer: AlohaCare Medicare |
$87.38
|
| Rate for Payer: Cash Price |
$116.48
|
| Rate for Payer: Cash Price |
$116.48
|
| Rate for Payer: Devoted Health Medicare |
$96.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$88.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$109.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$88.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.86
|
| Rate for Payer: Health Management Network Commercial |
$165.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.38
|
| Rate for Payer: University Health Alliance Commercial |
$102.27
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN
|
Professional
|
Both
|
$133.26
|
|
|
Service Code
|
HCPCS 96158
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: AlohaCare Medicaid |
$58.99
|
| Rate for Payer: AlohaCare Medicare |
$60.20
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Devoted Health Medicare |
$66.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.60
|
| Rate for Payer: Health Management Network Commercial |
$113.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.20
|
| Rate for Payer: University Health Alliance Commercial |
$69.55
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN
|
Professional
|
Both
|
$45.94
|
|
|
Service Code
|
HCPCS 96159
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: AlohaCare Medicaid |
$19.79
|
| Rate for Payer: AlohaCare Medicare |
$20.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Devoted Health Medicare |
$22.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.41
|
| Rate for Payer: Health Management Network Commercial |
$39.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.56
|
| Rate for Payer: University Health Alliance Commercial |
$23.57
|
|
|
PR HEMIARTHROPLASTY HIP PARTIAL
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 27125
|
| Min. Negotiated Rate |
$931.06 |
| Max. Negotiated Rate |
$1,687.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,156.11
|
| Rate for Payer: AlohaCare Medicare |
$1,039.51
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Devoted Health Medicare |
$1,143.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,039.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$931.06
|
| Rate for Payer: Health Management Network Commercial |
$1,687.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,247.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,247.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,156.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,039.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,156.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,039.51
|
|
|
PR HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE
|
Professional
|
Both
|
$767.15
|
|
|
Service Code
|
HCPCS 28160
|
| Min. Negotiated Rate |
$248.04 |
| Max. Negotiated Rate |
$652.08 |
| Rate for Payer: AlohaCare Medicaid |
$283.32
|
| Rate for Payer: AlohaCare Medicare |
$265.96
|
| Rate for Payer: Cash Price |
$460.29
|
| Rate for Payer: Cash Price |
$460.29
|
| Rate for Payer: Devoted Health Medicare |
$292.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$283.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$430.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$283.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$248.04
|
| Rate for Payer: Health Management Network Commercial |
$652.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$319.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$265.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$283.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.96
|
| Rate for Payer: University Health Alliance Commercial |
$364.15
|
|
|
PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Professional
|
Both
|
$618.48
|
|
|
Service Code
|
HCPCS 46221
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$525.71 |
| Rate for Payer: AlohaCare Medicaid |
$203.28
|
| Rate for Payer: AlohaCare Medicare |
$206.83
|
| Rate for Payer: Cash Price |
$371.09
|
| Rate for Payer: Cash Price |
$371.09
|
| Rate for Payer: Devoted Health Medicare |
$227.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$203.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$317.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$203.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$525.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.83
|
|
|
PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO
|
Professional
|
Both
|
$858.78
|
|
|
Service Code
|
HCPCS 46260
|
| Min. Negotiated Rate |
$490.35 |
| Max. Negotiated Rate |
$729.96 |
| Rate for Payer: AlohaCare Medicaid |
$497.47
|
| Rate for Payer: AlohaCare Medicare |
$490.35
|
| Rate for Payer: Cash Price |
$515.27
|
| Rate for Payer: Cash Price |
$515.27
|
| Rate for Payer: Devoted Health Medicare |
$539.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$490.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$519.48
|
| Rate for Payer: Health Management Network Commercial |
$729.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$588.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$588.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$588.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$497.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$490.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$497.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$490.35
|
|
|
PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP
|
Professional
|
Both
|
$1,087.96
|
|
|
Service Code
|
HCPCS 46255
|
| Min. Negotiated Rate |
$359.65 |
| Max. Negotiated Rate |
$924.77 |
| Rate for Payer: AlohaCare Medicaid |
$367.21
|
| Rate for Payer: AlohaCare Medicare |
$359.65
|
| Rate for Payer: Cash Price |
$652.78
|
| Rate for Payer: Cash Price |
$652.78
|
| Rate for Payer: Devoted Health Medicare |
$395.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$367.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$575.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$367.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.44
|
| Rate for Payer: Health Management Network Commercial |
$924.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$431.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.65
|
| Rate for Payer: University Health Alliance Commercial |
$487.39
|
|
|
PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Professional
|
Both
|
$1,007.46
|
|
|
Service Code
|
HCPCS 46250
|
| Min. Negotiated Rate |
$301.34 |
| Max. Negotiated Rate |
$856.34 |
| Rate for Payer: AlohaCare Medicaid |
$331.19
|
| Rate for Payer: AlohaCare Medicare |
$327.70
|
| Rate for Payer: Cash Price |
$604.48
|
| Rate for Payer: Cash Price |
$604.48
|
| Rate for Payer: Devoted Health Medicare |
$360.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$331.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$517.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$327.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$331.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.34
|
| Rate for Payer: Health Management Network Commercial |
$856.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$393.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$327.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$327.70
|
| Rate for Payer: University Health Alliance Commercial |
$438.56
|
|
|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 90633
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.02
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
