|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$1,864.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$809.64 |
| Max. Negotiated Rate |
$1,584.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.94
|
| Rate for Payer: AlohaCare Medicare |
$977.39
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Devoted Health Medicare |
$1,075.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$977.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$809.64
|
| Rate for Payer: Health Management Network Commercial |
$1,584.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,172.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,172.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,172.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$977.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$977.39
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$757.12 |
| Max. Negotiated Rate |
$1,317.50 |
| Rate for Payer: AlohaCare Medicaid |
$902.22
|
| Rate for Payer: AlohaCare Medicare |
$822.40
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Devoted Health Medicare |
$904.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$822.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$757.12
|
| Rate for Payer: Health Management Network Commercial |
$1,317.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$986.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$902.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$822.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$902.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$822.40
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$684.32 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: AlohaCare Medicaid |
$925.98
|
| Rate for Payer: AlohaCare Medicare |
$843.70
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$928.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$843.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$684.32
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$925.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$843.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$925.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$843.70
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$641.67 |
| Max. Negotiated Rate |
$1,008.10 |
| Rate for Payer: AlohaCare Medicaid |
$688.98
|
| Rate for Payer: AlohaCare Medicare |
$641.67
|
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Devoted Health Medicare |
$705.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.66
|
| Rate for Payer: Health Management Network Commercial |
$1,008.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$770.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$770.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$688.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.67
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$625.56 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: AlohaCare Medicaid |
$829.27
|
| Rate for Payer: AlohaCare Medicare |
$760.33
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Devoted Health Medicare |
$836.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$760.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$625.56
|
| Rate for Payer: Health Management Network Commercial |
$1,211.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$912.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$912.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$912.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$829.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$760.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$829.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$760.33
|
|
|
PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 27698
|
| Min. Negotiated Rate |
$593.58 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: AlohaCare Medicaid |
$661.73
|
| Rate for Payer: AlohaCare Medicare |
$607.81
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Devoted Health Medicare |
$668.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$607.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$966.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$729.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$607.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$607.81
|
|
|
PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$938.07
|
|
|
Service Code
|
HCPCS 28208
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$797.36 |
| Rate for Payer: AlohaCare Medicaid |
$339.97
|
| Rate for Payer: AlohaCare Medicare |
$321.47
|
| Rate for Payer: Cash Price |
$562.84
|
| Rate for Payer: Cash Price |
$562.84
|
| Rate for Payer: Devoted Health Medicare |
$353.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$339.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$513.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$339.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$797.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.47
|
| Rate for Payer: University Health Alliance Commercial |
$421.92
|
|
|
PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 24341
|
| Min. Negotiated Rate |
$449.02 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: AlohaCare Medicaid |
$791.82
|
| Rate for Payer: AlohaCare Medicare |
$728.67
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Devoted Health Medicare |
$801.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$728.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.02
|
| Rate for Payer: Health Management Network Commercial |
$1,154.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$874.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$874.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$874.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$791.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$728.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$791.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$728.67
|
|
|
PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 90867
|
| Min. Negotiated Rate |
$130.37 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.90
|
| Rate for Payer: Health Management Network Commercial |
$614.55
|
|
|
PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,177.08
|
|
|
Service Code
|
HCPCS 49451
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,000.52 |
| Rate for Payer: AlohaCare Medicaid |
$85.64
|
| Rate for Payer: AlohaCare Medicare |
$74.48
|
| Rate for Payer: Cash Price |
$706.25
|
| Rate for Payer: Cash Price |
$706.25
|
| Rate for Payer: Devoted Health Medicare |
$81.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$85.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$136.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$85.64
|
| Rate for Payer: Health Management Network Commercial |
$1,000.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.48
|
| Rate for Payer: University Health Alliance Commercial |
$115.44
|
|
|
PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$1,107.63
|
|
|
Service Code
|
HCPCS 49450
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$941.49 |
| Rate for Payer: AlohaCare Medicaid |
$63.37
|
| Rate for Payer: AlohaCare Medicare |
$55.30
|
| Rate for Payer: Cash Price |
$664.58
|
| Rate for Payer: Cash Price |
$664.58
|
| Rate for Payer: Devoted Health Medicare |
$60.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$63.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$99.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$731.38
|
| Rate for Payer: Health Management Network Commercial |
$941.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.30
|
|
|
PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$1,416.70
|
|
|
Service Code
|
HCPCS 49452
|
| Min. Negotiated Rate |
$114.56 |
| Max. Negotiated Rate |
$1,204.19 |
| Rate for Payer: AlohaCare Medicaid |
$131.78
|
| Rate for Payer: AlohaCare Medicare |
$114.56
|
| Rate for Payer: Cash Price |
$850.02
|
| Rate for Payer: Cash Price |
$850.02
|
| Rate for Payer: Devoted Health Medicare |
$126.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$209.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.78
|
| Rate for Payer: Health Management Network Commercial |
$1,204.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.56
|
| Rate for Payer: University Health Alliance Commercial |
$164.29
|
|
|
PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 11970
|
| Min. Negotiated Rate |
$529.70 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: AlohaCare Medicaid |
$583.94
|
| Rate for Payer: AlohaCare Medicare |
$529.70
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Devoted Health Medicare |
$582.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$529.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$578.24
|
| Rate for Payer: Health Management Network Commercial |
$853.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$635.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$635.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$635.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$583.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$529.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$583.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$529.70
|
|
|
PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO
|
Professional
|
Both
|
$219.75
|
|
|
Service Code
|
HCPCS 43761
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: AlohaCare Medicaid |
$101.17
|
| Rate for Payer: AlohaCare Medicare |
$86.45
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Devoted Health Medicare |
$95.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$159.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$186.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.45
|
| Rate for Payer: University Health Alliance Commercial |
$135.38
|
|
|
PR RESCJ LIP > ONE-FOURTH W/O RCNSTJ
|
Professional
|
Both
|
$1,054.53
|
|
|
Service Code
|
HCPCS 40530
|
| Min. Negotiated Rate |
$316.42 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: AlohaCare Medicaid |
$424.78
|
| Rate for Payer: AlohaCare Medicare |
$376.63
|
| Rate for Payer: Cash Price |
$632.72
|
| Rate for Payer: Cash Price |
$632.72
|
| Rate for Payer: Devoted Health Medicare |
$414.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$424.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$655.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$424.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$316.42
|
| Rate for Payer: Health Management Network Commercial |
$896.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$424.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.63
|
| Rate for Payer: University Health Alliance Commercial |
$554.75
|
|
|
PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 48105
|
| Min. Negotiated Rate |
$2,492.19 |
| Max. Negotiated Rate |
$4,024.75 |
| Rate for Payer: AlohaCare Medicaid |
$2,762.44
|
| Rate for Payer: AlohaCare Medicare |
$2,492.19
|
| Rate for Payer: Cash Price |
$2,841.00
|
| Rate for Payer: Cash Price |
$2,841.00
|
| Rate for Payer: Devoted Health Medicare |
$2,741.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,492.19
|
| Rate for Payer: Health Management Network Commercial |
$4,024.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,990.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,990.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,990.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,762.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,492.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,762.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,492.19
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$365.04 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: AlohaCare Medicaid |
$506.09
|
| Rate for Payer: AlohaCare Medicare |
$461.54
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Devoted Health Medicare |
$507.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$461.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$365.04
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$553.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$553.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$461.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$461.54
|
| Rate for Payer: University Health Alliance Commercial |
$661.24
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 94375 26
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: AlohaCare Medicaid |
$42.82
|
| Rate for Payer: AlohaCare Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$16.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.23
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.77
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 94375 TC
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: AlohaCare Medicaid |
$42.82
|
| Rate for Payer: AlohaCare Medicare |
$31.33
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$34.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.23
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.33
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: AlohaCare Medicaid |
$42.82
|
| Rate for Payer: AlohaCare Medicare |
$46.11
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$50.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.23
|
| Rate for Payer: Health Management Network Commercial |
$99.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.11
|
|
|
PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 90378
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,618.16
|
| Rate for Payer: Health Management Network Commercial |
$1,071.00
|
|
|
PR REVASC INTRAVASC LITHOTRIPSY
|
Professional
|
Both
|
$5,476.00
|
|
|
Service Code
|
HCPCS C9764
|
| Min. Negotiated Rate |
$4,654.60 |
| Max. Negotiated Rate |
$4,654.60 |
| Rate for Payer: Cash Price |
$3,285.60
|
| Rate for Payer: Health Management Network Commercial |
$4,654.60
|
|
|
PR REVASC LITHOTRIP TIBI/PERONE
|
Professional
|
Both
|
$19,148.00
|
|
|
Service Code
|
HCPCS C9772
|
| Min. Negotiated Rate |
$16,275.80 |
| Max. Negotiated Rate |
$16,275.80 |
| Rate for Payer: Cash Price |
$11,488.80
|
| Rate for Payer: Health Management Network Commercial |
$16,275.80
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,218.90 |
| Rate for Payer: AlohaCare Medicaid |
$833.68
|
| Rate for Payer: AlohaCare Medicare |
$748.59
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Devoted Health Medicare |
$823.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$748.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network Commercial |
$1,218.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$898.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$898.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$833.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$748.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$833.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$748.59
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$424.84 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: AlohaCare Medicaid |
$695.56
|
| Rate for Payer: AlohaCare Medicare |
$628.07
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Devoted Health Medicare |
$690.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$628.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$424.84
|
| Rate for Payer: Health Management Network Commercial |
$1,016.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$753.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$753.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$753.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$695.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$695.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.07
|
|
