|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$532.48 |
| Max. Negotiated Rate |
$1,222.30 |
| Rate for Payer: AlohaCare Medicaid |
$843.01
|
| Rate for Payer: AlohaCare Medicare |
$750.98
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Devoted Health Medicare |
$826.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$532.48
|
| Rate for Payer: Health Management Network Commercial |
$1,222.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$901.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$901.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$843.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$843.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.98
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.31
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.46
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: AlohaCare Medicaid |
$100.82
|
| Rate for Payer: AlohaCare Medicare |
$90.93
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Devoted Health Medicare |
$100.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.64
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.93
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$153.23
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$130.25 |
| Rate for Payer: AlohaCare Medicaid |
$48.34
|
| Rate for Payer: AlohaCare Medicare |
$41.99
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Devoted Health Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.74
|
| Rate for Payer: Health Management Network Commercial |
$130.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.99
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$119.14
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$101.27 |
| Rate for Payer: AlohaCare Medicaid |
$41.76
|
| Rate for Payer: AlohaCare Medicare |
$38.08
|
| Rate for Payer: Cash Price |
$71.48
|
| Rate for Payer: Cash Price |
$71.48
|
| Rate for Payer: Devoted Health Medicare |
$41.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$101.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.08
|
| Rate for Payer: University Health Alliance Commercial |
$54.28
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: AlohaCare Medicaid |
$51.84
|
| Rate for Payer: AlohaCare Medicare |
$42.97
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Devoted Health Medicare |
$47.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$79.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.97
|
| Rate for Payer: University Health Alliance Commercial |
$67.40
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$757.70
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$644.04 |
| Rate for Payer: AlohaCare Medicaid |
$235.96
|
| Rate for Payer: AlohaCare Medicare |
$237.77
|
| Rate for Payer: Cash Price |
$454.62
|
| Rate for Payer: Cash Price |
$454.62
|
| Rate for Payer: Devoted Health Medicare |
$261.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$235.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$370.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$235.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.44
|
| Rate for Payer: Health Management Network Commercial |
$644.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$235.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.77
|
| Rate for Payer: University Health Alliance Commercial |
$313.74
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$940.43
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$186.68 |
| Max. Negotiated Rate |
$799.37 |
| Rate for Payer: AlohaCare Medicaid |
$254.47
|
| Rate for Payer: AlohaCare Medicare |
$236.99
|
| Rate for Payer: Cash Price |
$564.26
|
| Rate for Payer: Cash Price |
$564.26
|
| Rate for Payer: Devoted Health Medicare |
$260.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$254.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$393.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$236.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$254.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$186.68
|
| Rate for Payer: Health Management Network Commercial |
$799.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$284.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$284.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.99
|
| Rate for Payer: University Health Alliance Commercial |
$332.85
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$457.99
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$87.62 |
| Max. Negotiated Rate |
$389.29 |
| Rate for Payer: AlohaCare Medicaid |
$149.03
|
| Rate for Payer: AlohaCare Medicare |
$148.16
|
| Rate for Payer: Cash Price |
$274.79
|
| Rate for Payer: Cash Price |
$274.79
|
| Rate for Payer: Devoted Health Medicare |
$162.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$149.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.62
|
| Rate for Payer: Health Management Network Commercial |
$389.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.16
|
| Rate for Payer: University Health Alliance Commercial |
$193.83
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$2,766.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$1,237.60 |
| Max. Negotiated Rate |
$2,351.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,610.92
|
| Rate for Payer: AlohaCare Medicare |
$1,431.76
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Devoted Health Medicare |
$1,574.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,431.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,237.60
|
| Rate for Payer: Health Management Network Commercial |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,718.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,718.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,718.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,610.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,431.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,610.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,431.76
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$323.76 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: AlohaCare Medicaid |
$365.69
|
| Rate for Payer: AlohaCare Medicare |
$323.76
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Devoted Health Medicare |
$356.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$323.76
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$388.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$388.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$388.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$323.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$365.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$323.76
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$336.03 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: AlohaCare Medicaid |
$379.42
|
| Rate for Payer: AlohaCare Medicare |
$336.03
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Devoted Health Medicare |
$369.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$336.03
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$403.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$403.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$336.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$336.03
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$348.54 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: AlohaCare Medicaid |
$395.45
|
| Rate for Payer: AlohaCare Medicare |
$348.54
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Devoted Health Medicare |
$383.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$348.54
|
| Rate for Payer: Health Management Network Commercial |
$573.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$418.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$418.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$348.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$348.54
|
|
|
PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$348.64
|
|
|
Service Code
|
HCPCS 32552
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$296.34 |
| Rate for Payer: AlohaCare Medicaid |
$158.44
|
| Rate for Payer: AlohaCare Medicare |
$149.85
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Devoted Health Medicare |
$164.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.44
|
| Rate for Payer: Health Management Network Commercial |
$296.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.85
|
| Rate for Payer: University Health Alliance Commercial |
$196.25
|
|
|
PR RMVL NFROS TUBE REQ FLUORO GUIDANCE
|
Professional
|
Both
|
$776.39
|
|
|
Service Code
|
HCPCS 50389
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$659.93 |
| Rate for Payer: AlohaCare Medicaid |
$51.86
|
| Rate for Payer: AlohaCare Medicare |
$44.90
|
| Rate for Payer: Cash Price |
$465.83
|
| Rate for Payer: Cash Price |
$465.83
|
| Rate for Payer: Devoted Health Medicare |
$49.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.86
|
| Rate for Payer: Health Management Network Commercial |
$659.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.90
|
| Rate for Payer: University Health Alliance Commercial |
$86.00
|
|
|
PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 49623
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: AlohaCare Medicaid |
$190.83
|
| Rate for Payer: AlohaCare Medicare |
$174.80
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Devoted Health Medicare |
$192.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$283.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.80
|
|
|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$496.05 |
| Max. Negotiated Rate |
$794.75 |
| Rate for Payer: AlohaCare Medicaid |
$546.19
|
| Rate for Payer: AlohaCare Medicare |
$496.05
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$545.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$496.05
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$595.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$595.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$546.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$496.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$546.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$496.05
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$232.36 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: AlohaCare Medicaid |
$260.16
|
| Rate for Payer: AlohaCare Medicare |
$232.36
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$255.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.78
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$278.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.36
|
|
|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$2,107.00
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$1,104.40 |
| Max. Negotiated Rate |
$1,790.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,226.98
|
| Rate for Payer: AlohaCare Medicare |
$1,104.40
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Devoted Health Medicare |
$1,214.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,251.90
|
| Rate for Payer: Health Management Network Commercial |
$1,790.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,325.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,325.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,325.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,226.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,226.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.40
|
|
|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$786.10 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: AlohaCare Medicare |
$786.10
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Devoted Health Medicare |
$864.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$786.10
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$943.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$943.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$943.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$786.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$786.10
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,829.19
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$1,554.81 |
| Rate for Payer: AlohaCare Medicaid |
$242.97
|
| Rate for Payer: AlohaCare Medicare |
$212.42
|
| Rate for Payer: Cash Price |
$1,097.51
|
| Rate for Payer: Cash Price |
$1,097.51
|
| Rate for Payer: Devoted Health Medicare |
$233.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$242.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$385.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$242.97
|
| Rate for Payer: Health Management Network Commercial |
$1,554.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.42
|
| Rate for Payer: University Health Alliance Commercial |
$326.75
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$930.84 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: AlohaCare Medicare |
$930.84
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Devoted Health Medicare |
$1,023.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$930.84
|
| Rate for Payer: Health Management Network Commercial |
$1,514.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,117.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,117.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,117.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$930.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$930.84
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,014.88
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$862.65 |
| Rate for Payer: AlohaCare Medicaid |
$80.36
|
| Rate for Payer: AlohaCare Medicare |
$70.28
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Devoted Health Medicare |
$77.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$80.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$80.36
|
| Rate for Payer: Health Management Network Commercial |
$862.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.28
|
| Rate for Payer: University Health Alliance Commercial |
$107.84
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$342.16 |
| Max. Negotiated Rate |
$974.10 |
| Rate for Payer: AlohaCare Medicaid |
$666.18
|
| Rate for Payer: AlohaCare Medicare |
$602.03
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Devoted Health Medicare |
$662.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$602.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.16
|
| Rate for Payer: Health Management Network Commercial |
$974.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$722.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$722.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$722.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$666.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$602.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$666.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$602.03
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$33.34
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: AlohaCare Medicaid |
$16.33
|
| Rate for Payer: AlohaCare Medicare |
$12.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Devoted Health Medicare |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network Commercial |
$28.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.97
|
| Rate for Payer: University Health Alliance Commercial |
$18.87
|
|
