|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$224.27 |
| Max. Negotiated Rate |
$361.47 |
| Rate for Payer: AlohaCare Medicaid |
$240.13
|
| Rate for Payer: AlohaCare Medicare |
$224.27
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Devoted Health Medicare |
$246.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$361.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.12
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.27
|
|
|
PR LIG DIV & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$347.82 |
| Max. Negotiated Rate |
$544.85 |
| Rate for Payer: AlohaCare Medicaid |
$374.24
|
| Rate for Payer: AlohaCare Medicare |
$347.82
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Devoted Health Medicare |
$382.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$402.22
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$417.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$417.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$417.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$374.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.82
|
|
|
PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$407.86 |
| Max. Negotiated Rate |
$635.80 |
| Rate for Payer: AlohaCare Medicaid |
$441.11
|
| Rate for Payer: AlohaCare Medicare |
$407.86
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Devoted Health Medicare |
$448.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$407.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.42
|
| Rate for Payer: Health Management Network Commercial |
$635.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$489.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$407.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$441.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$407.86
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$610.59
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: AlohaCare Medicaid |
$251.44
|
| Rate for Payer: AlohaCare Medicare |
$230.80
|
| Rate for Payer: Cash Price |
$366.35
|
| Rate for Payer: Cash Price |
$366.35
|
| Rate for Payer: Devoted Health Medicare |
$253.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$251.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$400.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$251.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$519.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$251.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$251.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.80
|
| Rate for Payer: University Health Alliance Commercial |
$350.00
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$160.68 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: AlohaCare Medicaid |
$229.44
|
| Rate for Payer: AlohaCare Medicare |
$215.05
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Devoted Health Medicare |
$236.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.68
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.05
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: AlohaCare Medicare |
$63.13
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$69.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.42
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.13
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$499.80 |
| Rate for Payer: AlohaCare Medicaid |
$346.70
|
| Rate for Payer: AlohaCare Medicare |
$303.16
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Devoted Health Medicare |
$333.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.84
|
| Rate for Payer: Health Management Network Commercial |
$499.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$363.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$363.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$346.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$346.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.16
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: AlohaCare Medicaid |
$465.32
|
| Rate for Payer: AlohaCare Medicare |
$408.34
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Devoted Health Medicare |
$449.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.42
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$490.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$490.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$465.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.34
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,649.18
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$300.20 |
| Max. Negotiated Rate |
$1,401.80 |
| Rate for Payer: AlohaCare Medicaid |
$340.99
|
| Rate for Payer: AlohaCare Medicare |
$300.20
|
| Rate for Payer: Cash Price |
$989.51
|
| Rate for Payer: Cash Price |
$989.51
|
| Rate for Payer: Devoted Health Medicare |
$330.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$340.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$530.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$300.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$340.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.04
|
| Rate for Payer: Health Management Network Commercial |
$1,401.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$360.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$360.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$340.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.20
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,396.85
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$1,187.32 |
| Rate for Payer: AlohaCare Medicaid |
$583.80
|
| Rate for Payer: AlohaCare Medicare |
$525.91
|
| Rate for Payer: Cash Price |
$838.11
|
| Rate for Payer: Cash Price |
$838.11
|
| Rate for Payer: Devoted Health Medicare |
$578.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$583.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$896.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$583.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.50
|
| Rate for Payer: Health Management Network Commercial |
$1,187.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$631.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$631.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$631.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$583.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$583.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.91
|
| Rate for Payer: University Health Alliance Commercial |
$758.75
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: AlohaCare Medicaid |
$1.75
|
| Rate for Payer: AlohaCare Medicare |
$2.50
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.84
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.50
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: AlohaCare Medicaid |
$1.16
|
| Rate for Payer: AlohaCare Medicare |
$1.64
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.64
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.64
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$486.04
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$184.34 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: AlohaCare Medicaid |
$205.95
|
| Rate for Payer: AlohaCare Medicare |
$186.98
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Devoted Health Medicare |
$205.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$205.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$315.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$186.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$205.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.34
|
| Rate for Payer: Health Management Network Commercial |
$413.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$224.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$186.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$186.98
|
| Rate for Payer: University Health Alliance Commercial |
$256.06
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$489.32 |
| Max. Negotiated Rate |
$1,323.45 |
| Rate for Payer: AlohaCare Medicaid |
$912.60
|
| Rate for Payer: AlohaCare Medicare |
$817.12
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Devoted Health Medicare |
$898.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$817.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$489.32
|
| Rate for Payer: Health Management Network Commercial |
$1,323.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$980.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$980.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$912.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$817.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$912.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$817.12
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$235.22
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$75.93 |
| Max. Negotiated Rate |
$199.94 |
| Rate for Payer: AlohaCare Medicaid |
$83.19
|
| Rate for Payer: AlohaCare Medicare |
$75.93
|
| Rate for Payer: Cash Price |
$141.13
|
| Rate for Payer: Cash Price |
$141.13
|
| Rate for Payer: Devoted Health Medicare |
$83.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.19
|
| Rate for Payer: Health Management Network Commercial |
$199.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.93
|
| Rate for Payer: University Health Alliance Commercial |
$108.03
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$689.57
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$393.66 |
| Max. Negotiated Rate |
$586.13 |
| Rate for Payer: AlohaCare Medicaid |
$398.57
|
| Rate for Payer: AlohaCare Medicare |
$393.66
|
| Rate for Payer: Cash Price |
$413.74
|
| Rate for Payer: Cash Price |
$413.74
|
| Rate for Payer: Devoted Health Medicare |
$433.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.66
|
| Rate for Payer: Health Management Network Commercial |
$586.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$398.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.66
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: AlohaCare Medicaid |
$163.64
|
| Rate for Payer: AlohaCare Medicare |
$155.61
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$171.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.61
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$148.63
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.27
|
| Rate for Payer: AlohaCare Medicare |
$68.98
|
| Rate for Payer: Cash Price |
$89.18
|
| Rate for Payer: Cash Price |
$89.18
|
| Rate for Payer: Devoted Health Medicare |
$75.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.98
|
| Rate for Payer: Health Management Network Commercial |
$126.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.98
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$258.90
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$220.06 |
| Rate for Payer: AlohaCare Medicaid |
$140.18
|
| Rate for Payer: AlohaCare Medicare |
$119.46
|
| Rate for Payer: Cash Price |
$155.34
|
| Rate for Payer: Cash Price |
$155.34
|
| Rate for Payer: Devoted Health Medicare |
$131.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.46
|
| Rate for Payer: Health Management Network Commercial |
$220.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.46
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: AlohaCare Medicaid |
$28.65
|
| Rate for Payer: AlohaCare Medicare |
$29.37
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$32.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.92
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.37
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,187.76
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$437.95 |
| Max. Negotiated Rate |
$1,009.60 |
| Rate for Payer: AlohaCare Medicaid |
$449.29
|
| Rate for Payer: AlohaCare Medicare |
$437.95
|
| Rate for Payer: Cash Price |
$712.66
|
| Rate for Payer: Cash Price |
$712.66
|
| Rate for Payer: Devoted Health Medicare |
$481.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$671.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.16
|
| Rate for Payer: Health Management Network Commercial |
$1,009.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$525.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$525.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$525.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$449.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.95
|
| Rate for Payer: University Health Alliance Commercial |
$491.01
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$349.44 |
| Max. Negotiated Rate |
$962.20 |
| Rate for Payer: AlohaCare Medicaid |
$661.92
|
| Rate for Payer: AlohaCare Medicare |
$626.73
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Devoted Health Medicare |
$689.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.44
|
| Rate for Payer: Health Management Network Commercial |
$962.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.73
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$751.92 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: AlohaCare Medicaid |
$907.77
|
| Rate for Payer: AlohaCare Medicare |
$858.42
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Devoted Health Medicare |
$944.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$858.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.92
|
| Rate for Payer: Health Management Network Commercial |
$1,320.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,030.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,030.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,030.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$907.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$858.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$907.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$858.42
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$746.98 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: AlohaCare Medicaid |
$956.40
|
| Rate for Payer: AlohaCare Medicare |
$904.49
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Devoted Health Medicare |
$994.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$904.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.98
|
| Rate for Payer: Health Management Network Commercial |
$1,394.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,085.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,085.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,085.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$956.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$904.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$956.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$904.49
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,021.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$991.12 |
| Max. Negotiated Rate |
$1,717.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,181.41
|
| Rate for Payer: AlohaCare Medicare |
$1,116.27
|
| Rate for Payer: Cash Price |
$1,212.60
|
| Rate for Payer: Cash Price |
$1,212.60
|
| Rate for Payer: Devoted Health Medicare |
$1,227.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,116.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$991.12
|
| Rate for Payer: Health Management Network Commercial |
$1,717.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,339.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,339.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,339.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,181.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,116.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,181.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,116.27
|
|
