|
PR REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$24.15
|
|
|
Service Code
|
HCPCS G2010
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.96
|
| Rate for Payer: Health Management Network Commercial |
$20.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.10
|
|
|
PR REMOVAL ANAL SETON OTHER MARKER
|
Professional
|
Both
|
$545.54
|
|
|
Service Code
|
HCPCS 46030
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$463.71 |
| Rate for Payer: AlohaCare Medicaid |
$87.02
|
| Rate for Payer: AlohaCare Medicare |
$80.46
|
| Rate for Payer: Cash Price |
$327.32
|
| Rate for Payer: Cash Price |
$327.32
|
| Rate for Payer: Devoted Health Medicare |
$88.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$136.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.94
|
| Rate for Payer: Health Management Network Commercial |
$463.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.46
|
| Rate for Payer: University Health Alliance Commercial |
$115.00
|
|
|
PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I
|
Professional
|
Both
|
$900.27
|
|
|
Service Code
|
HCPCS 47537
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$765.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.63
|
| Rate for Payer: AlohaCare Medicare |
$83.40
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Devoted Health Medicare |
$91.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$148.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$462.02
|
| Rate for Payer: Health Management Network Commercial |
$765.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.40
|
| Rate for Payer: University Health Alliance Commercial |
$125.69
|
|
|
PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I
|
Professional
|
Both
|
$1,540.72
|
|
|
Service Code
|
HCPCS 47544
|
| Min. Negotiated Rate |
$131.51 |
| Max. Negotiated Rate |
$1,309.61 |
| Rate for Payer: AlohaCare Medicaid |
$150.14
|
| Rate for Payer: AlohaCare Medicare |
$131.51
|
| Rate for Payer: Cash Price |
$924.43
|
| Rate for Payer: Cash Price |
$924.43
|
| Rate for Payer: Devoted Health Medicare |
$144.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$308.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.14
|
| Rate for Payer: Health Management Network Commercial |
$1,309.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.51
|
| Rate for Payer: University Health Alliance Commercial |
$200.51
|
|
|
PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST
|
Professional
|
Both
|
$128.06
|
|
|
Service Code
|
HCPCS 29705
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$108.85 |
| Rate for Payer: AlohaCare Medicaid |
$44.75
|
| Rate for Payer: AlohaCare Medicare |
$40.52
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Devoted Health Medicare |
$44.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$69.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.54
|
| Rate for Payer: Health Management Network Commercial |
$108.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.52
|
| Rate for Payer: University Health Alliance Commercial |
$59.11
|
|
|
PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE
|
Professional
|
Both
|
$1,509.41
|
|
|
Service Code
|
HCPCS 21029
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$1,283.00 |
| Rate for Payer: AlohaCare Medicaid |
$653.49
|
| Rate for Payer: AlohaCare Medicare |
$586.81
|
| Rate for Payer: Cash Price |
$905.65
|
| Rate for Payer: Cash Price |
$905.65
|
| Rate for Payer: Devoted Health Medicare |
$645.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$653.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$995.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$586.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$653.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$477.36
|
| Rate for Payer: Health Management Network Commercial |
$1,283.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$704.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$704.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$704.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$586.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$586.81
|
| Rate for Payer: University Health Alliance Commercial |
$843.19
|
|
|
PR REMOVAL DEEP DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$115.27
|
|
|
Service Code
|
HCPCS 20701
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: AlohaCare Medicaid |
$63.14
|
| Rate for Payer: AlohaCare Medicare |
$53.33
|
| Rate for Payer: Cash Price |
$69.16
|
| Rate for Payer: Cash Price |
$69.16
|
| Rate for Payer: Devoted Health Medicare |
$58.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.33
|
| Rate for Payer: Health Management Network Commercial |
$97.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.33
|
|
|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$415.65 |
| Rate for Payer: AlohaCare Medicaid |
$125.64
|
| Rate for Payer: AlohaCare Medicare |
$106.63
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Devoted Health Medicare |
$117.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$415.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.63
|
| Rate for Payer: University Health Alliance Commercial |
$160.88
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$859.97
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$730.97 |
| Rate for Payer: AlohaCare Medicaid |
$362.04
|
| Rate for Payer: AlohaCare Medicare |
$339.51
|
| Rate for Payer: Cash Price |
$515.98
|
| Rate for Payer: Cash Price |
$515.98
|
| Rate for Payer: Devoted Health Medicare |
$373.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$362.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$549.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$362.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$302.38
|
| Rate for Payer: Health Management Network Commercial |
$730.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$362.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$362.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.51
|
| Rate for Payer: University Health Alliance Commercial |
$465.01
|
|
|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$51.33
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: AlohaCare Medicaid |
$29.88
|
| Rate for Payer: AlohaCare Medicare |
$25.15
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Devoted Health Medicare |
$27.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.54
|
| Rate for Payer: Health Management Network Commercial |
$43.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.15
|
| Rate for Payer: University Health Alliance Commercial |
$39.97
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$864.04
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$734.43 |
| Rate for Payer: AlohaCare Medicaid |
$440.37
|
| Rate for Payer: AlohaCare Medicare |
$402.98
|
| Rate for Payer: Cash Price |
$518.42
|
| Rate for Payer: Cash Price |
$518.42
|
| Rate for Payer: Devoted Health Medicare |
$443.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$440.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$440.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$344.50
|
| Rate for Payer: Health Management Network Commercial |
$734.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$483.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$483.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$440.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$440.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.98
|
| Rate for Payer: University Health Alliance Commercial |
$570.53
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,196.46
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,016.99 |
| Rate for Payer: AlohaCare Medicaid |
$418.67
|
| Rate for Payer: AlohaCare Medicare |
$401.90
|
| Rate for Payer: Cash Price |
$717.88
|
| Rate for Payer: Cash Price |
$717.88
|
| Rate for Payer: Devoted Health Medicare |
$442.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$418.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$648.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$418.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.14
|
| Rate for Payer: Health Management Network Commercial |
$1,016.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$418.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$418.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.90
|
| Rate for Payer: University Health Alliance Commercial |
$549.35
|
|
|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$856.85
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$728.32 |
| Rate for Payer: Devoted Health Medicare |
$334.31
|
| Rate for Payer: AlohaCare Medicaid |
$326.24
|
| Rate for Payer: AlohaCare Medicare |
$303.92
|
| Rate for Payer: Cash Price |
$514.11
|
| Rate for Payer: Cash Price |
$514.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$326.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$497.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$326.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$274.30
|
| Rate for Payer: Health Management Network Commercial |
$728.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.92
|
| Rate for Payer: University Health Alliance Commercial |
$421.14
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$453.97
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: AlohaCare Medicaid |
$139.11
|
| Rate for Payer: AlohaCare Medicare |
$132.19
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Devoted Health Medicare |
$145.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.24
|
| Rate for Payer: Health Management Network Commercial |
$385.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.19
|
| Rate for Payer: University Health Alliance Commercial |
$172.62
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: AlohaCare Medicaid |
$225.31
|
| Rate for Payer: AlohaCare Medicare |
$202.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Devoted Health Medicare |
$222.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.98
|
| Rate for Payer: Health Management Network Commercial |
$321.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.28
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$410.30
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: AlohaCare Medicaid |
$133.74
|
| Rate for Payer: AlohaCare Medicare |
$123.57
|
| Rate for Payer: Cash Price |
$246.18
|
| Rate for Payer: Cash Price |
$246.18
|
| Rate for Payer: Devoted Health Medicare |
$135.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$201.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$348.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.57
|
| Rate for Payer: University Health Alliance Commercial |
$162.22
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$433.62
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$368.58 |
| Rate for Payer: AlohaCare Medicaid |
$155.87
|
| Rate for Payer: AlohaCare Medicare |
$147.90
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Devoted Health Medicare |
$162.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$155.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$368.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.90
|
| Rate for Payer: University Health Alliance Commercial |
$201.87
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$403.04
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: AlohaCare Medicaid |
$131.77
|
| Rate for Payer: AlohaCare Medicare |
$119.42
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Devoted Health Medicare |
$131.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$202.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.74
|
| Rate for Payer: Health Management Network Commercial |
$342.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.42
|
| Rate for Payer: University Health Alliance Commercial |
$171.04
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$536.35 |
| Rate for Payer: AlohaCare Medicaid |
$367.94
|
| Rate for Payer: AlohaCare Medicare |
$337.96
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Devoted Health Medicare |
$371.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$203.58
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.96
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$625.43
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$531.62 |
| Rate for Payer: AlohaCare Medicaid |
$178.39
|
| Rate for Payer: AlohaCare Medicare |
$173.20
|
| Rate for Payer: Cash Price |
$375.26
|
| Rate for Payer: Cash Price |
$375.26
|
| Rate for Payer: Devoted Health Medicare |
$190.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$178.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$253.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$178.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$531.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$178.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.20
|
| Rate for Payer: University Health Alliance Commercial |
$229.54
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$88.02
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: AlohaCare Medicaid |
$32.51
|
| Rate for Payer: AlohaCare Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Devoted Health Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.48
|
| Rate for Payer: Health Management Network Commercial |
$74.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.76
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$33.56
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: AlohaCare Medicaid |
$18.16
|
| Rate for Payer: AlohaCare Medicare |
$19.18
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Devoted Health Medicare |
$21.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.82
|
| Rate for Payer: Health Management Network Commercial |
$28.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.18
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$268.03
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$77.59 |
| Max. Negotiated Rate |
$227.83 |
| Rate for Payer: AlohaCare Medicaid |
$91.24
|
| Rate for Payer: AlohaCare Medicare |
$77.59
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Devoted Health Medicare |
$85.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$143.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.02
|
| Rate for Payer: Health Management Network Commercial |
$227.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.59
|
| Rate for Payer: University Health Alliance Commercial |
$98.21
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: AlohaCare Medicaid |
$214.86
|
| Rate for Payer: AlohaCare Medicare |
$198.23
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Devoted Health Medicare |
$218.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$172.90
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$214.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.23
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,176.32
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$999.87 |
| Rate for Payer: AlohaCare Medicaid |
$435.82
|
| Rate for Payer: AlohaCare Medicare |
$402.16
|
| Rate for Payer: Cash Price |
$705.79
|
| Rate for Payer: Cash Price |
$705.79
|
| Rate for Payer: Devoted Health Medicare |
$442.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$435.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$668.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$435.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.74
|
| Rate for Payer: Health Management Network Commercial |
$999.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.16
|
| Rate for Payer: University Health Alliance Commercial |
$542.81
|
|
