|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 49615
|
| Min. Negotiated Rate |
$558.49 |
| Max. Negotiated Rate |
$901.00 |
| Rate for Payer: AlohaCare Medicaid |
$619.06
|
| Rate for Payer: AlohaCare Medicare |
$558.49
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Devoted Health Medicare |
$614.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$558.49
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$670.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$670.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$670.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$619.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$558.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$619.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$558.49
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 49614
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: AlohaCare Medicaid |
$553.48
|
| Rate for Payer: AlohaCare Medicare |
$501.50
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Devoted Health Medicare |
$551.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$501.50
|
| Rate for Payer: Health Management Network Commercial |
$805.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$553.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$501.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$553.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$501.50
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 49613
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: AlohaCare Medicaid |
$410.64
|
| Rate for Payer: AlohaCare Medicare |
$372.40
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Devoted Health Medicare |
$409.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.40
|
| Rate for Payer: Health Management Network Commercial |
$596.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$446.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$446.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.40
|
|
|
PR RPR ACQUIRED/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$657.94 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$720.79
|
| Rate for Payer: AlohaCare Medicare |
$657.94
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$723.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$657.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$681.20
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$789.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$789.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$720.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$657.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$720.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$657.94
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$1,382.82
|
|
|
Service Code
|
HCPCS 26350
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,175.40 |
| Rate for Payer: AlohaCare Medicaid |
$814.69
|
| Rate for Payer: AlohaCare Medicare |
$790.18
|
| Rate for Payer: Cash Price |
$829.69
|
| Rate for Payer: Cash Price |
$829.69
|
| Rate for Payer: Devoted Health Medicare |
$869.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$790.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.56
|
| Rate for Payer: Health Management Network Commercial |
$1,175.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$948.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$948.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$948.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$814.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$790.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$814.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$790.18
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 26356
|
| Min. Negotiated Rate |
$699.66 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: AlohaCare Medicaid |
$845.05
|
| Rate for Payer: AlohaCare Medicare |
$780.75
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Devoted Health Medicare |
$858.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$780.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$699.66
|
| Rate for Payer: Health Management Network Commercial |
$1,233.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$936.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$936.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$936.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$845.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$780.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$845.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$780.75
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 26370
|
| Min. Negotiated Rate |
$614.38 |
| Max. Negotiated Rate |
$1,220.60 |
| Rate for Payer: AlohaCare Medicaid |
$846.98
|
| Rate for Payer: AlohaCare Medicare |
$806.51
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Devoted Health Medicare |
$887.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$806.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$614.38
|
| Rate for Payer: Health Management Network Commercial |
$1,220.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$967.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$967.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$967.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$846.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$806.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$846.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$806.51
|
|
|
PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 35286
|
| Min. Negotiated Rate |
$696.28 |
| Max. Negotiated Rate |
$1,263.95 |
| Rate for Payer: AlohaCare Medicaid |
$871.88
|
| Rate for Payer: AlohaCare Medicare |
$800.93
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Devoted Health Medicare |
$881.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$800.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$696.28
|
| Rate for Payer: Health Management Network Commercial |
$1,263.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$961.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$961.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$961.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$871.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$800.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$871.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$800.93
|
|
|
PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$1,284.00
|
|
|
Service Code
|
HCPCS 26540
|
| Min. Negotiated Rate |
$439.66 |
| Max. Negotiated Rate |
$1,091.40 |
| Rate for Payer: AlohaCare Medicaid |
$756.70
|
| Rate for Payer: AlohaCare Medicare |
$719.87
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Devoted Health Medicare |
$791.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$719.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$439.66
|
| Rate for Payer: Health Management Network Commercial |
$1,091.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$863.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$863.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$863.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$756.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$719.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$756.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$719.87
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$758.16 |
| Max. Negotiated Rate |
$1,229.10 |
| Rate for Payer: AlohaCare Medicaid |
$850.77
|
| Rate for Payer: AlohaCare Medicare |
$798.13
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Devoted Health Medicare |
$877.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$798.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$758.16
|
| Rate for Payer: Health Management Network Commercial |
$1,229.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$957.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$957.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$957.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$850.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$798.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$850.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$798.13
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$291.98 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: AlohaCare Medicaid |
$384.31
|
| Rate for Payer: AlohaCare Medicare |
$356.83
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Devoted Health Medicare |
$392.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.98
|
| Rate for Payer: Health Management Network Commercial |
$551.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$384.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.83
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 54344
|
| Min. Negotiated Rate |
$849.77 |
| Max. Negotiated Rate |
$1,385.50 |
| Rate for Payer: AlohaCare Medicaid |
$951.72
|
| Rate for Payer: AlohaCare Medicare |
$849.77
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Devoted Health Medicare |
$934.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$849.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$922.74
|
| Rate for Payer: Health Management Network Commercial |
$1,385.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,019.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$951.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$849.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$951.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$849.77
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: AlohaCare Medicaid |
$575.07
|
| Rate for Payer: AlohaCare Medicare |
$548.07
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Devoted Health Medicare |
$602.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$379.86
|
| Rate for Payer: Health Management Network Commercial |
$839.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$657.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$657.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$575.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$575.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.07
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$1,039.13
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$883.26 |
| Rate for Payer: AlohaCare Medicaid |
$323.16
|
| Rate for Payer: AlohaCare Medicare |
$316.18
|
| Rate for Payer: Cash Price |
$623.48
|
| Rate for Payer: Cash Price |
$623.48
|
| Rate for Payer: Devoted Health Medicare |
$347.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$323.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$482.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$323.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$883.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$323.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.18
|
| Rate for Payer: University Health Alliance Commercial |
$351.47
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$645.35
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$548.55 |
| Rate for Payer: AlohaCare Medicaid |
$215.81
|
| Rate for Payer: AlohaCare Medicare |
$199.39
|
| Rate for Payer: Cash Price |
$387.21
|
| Rate for Payer: Cash Price |
$387.21
|
| Rate for Payer: Devoted Health Medicare |
$219.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$215.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$332.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$215.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.72
|
| Rate for Payer: Health Management Network Commercial |
$548.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$215.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.39
|
| Rate for Payer: University Health Alliance Commercial |
$281.51
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$782.60 |
| Max. Negotiated Rate |
$1,624.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,114.48
|
| Rate for Payer: AlohaCare Medicare |
$1,028.52
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Devoted Health Medicare |
$1,131.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,028.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$782.60
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,234.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,234.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,234.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,114.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,028.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,114.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,028.52
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$8,109.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$918.06 |
| Max. Negotiated Rate |
$6,892.65 |
| Rate for Payer: AlohaCare Medicaid |
$4,737.60
|
| Rate for Payer: AlohaCare Medicare |
$4,294.00
|
| Rate for Payer: Cash Price |
$4,865.40
|
| Rate for Payer: Cash Price |
$4,865.40
|
| Rate for Payer: Devoted Health Medicare |
$4,723.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,294.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$918.06
|
| Rate for Payer: Health Management Network Commercial |
$6,892.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,152.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,152.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,152.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,737.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,294.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,737.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,294.00
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$1,838.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$848.12 |
| Max. Negotiated Rate |
$1,562.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,067.66
|
| Rate for Payer: AlohaCare Medicare |
$947.47
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Devoted Health Medicare |
$1,042.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$947.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$848.12
|
| Rate for Payer: Health Management Network Commercial |
$1,562.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,136.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,136.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,067.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$947.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,067.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$947.47
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$747.56 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$832.71
|
| Rate for Payer: AlohaCare Medicare |
$747.56
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Devoted Health Medicare |
$822.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$747.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$915.98
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$897.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$832.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$747.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$832.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$747.56
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$558.74 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,111.72
|
| Rate for Payer: AlohaCare Medicare |
$1,043.46
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Devoted Health Medicare |
$1,147.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,043.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.74
|
| Rate for Payer: Health Management Network Commercial |
$1,618.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,252.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,252.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,252.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,111.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,043.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,111.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,043.46
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$598.52 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: AlohaCare Medicaid |
$800.94
|
| Rate for Payer: AlohaCare Medicare |
$716.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Devoted Health Medicare |
$788.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$716.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$598.52
|
| Rate for Payer: Health Management Network Commercial |
$1,171.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$859.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$859.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$800.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$716.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$800.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$716.40
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$4,731.56
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$145.63 |
| Max. Negotiated Rate |
$4,021.83 |
| Rate for Payer: AlohaCare Medicaid |
$171.81
|
| Rate for Payer: AlohaCare Medicare |
$145.63
|
| Rate for Payer: Cash Price |
$2,838.94
|
| Rate for Payer: Cash Price |
$2,838.94
|
| Rate for Payer: Devoted Health Medicare |
$160.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$264.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.81
|
| Rate for Payer: Health Management Network Commercial |
$4,021.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.63
|
| Rate for Payer: University Health Alliance Commercial |
$213.45
|
|
|
PR RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
HCPCS 49610
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: AlohaCare Medicaid |
$692.94
|
| Rate for Payer: AlohaCare Medicare |
$651.84
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Devoted Health Medicare |
$717.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$651.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$490.88
|
| Rate for Payer: Health Management Network Commercial |
$1,010.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$782.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$782.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$692.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$651.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$692.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$651.84
|
|
|
PR RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 49611
|
| Min. Negotiated Rate |
$525.46 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: AlohaCare Medicaid |
$614.09
|
| Rate for Payer: AlohaCare Medicare |
$584.07
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Devoted Health Medicare |
$642.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$584.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.46
|
| Rate for Payer: Health Management Network Commercial |
$895.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$700.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$700.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$614.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$584.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$614.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$584.07
|
|
|
PR RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 49621
|
| Min. Negotiated Rate |
$656.98 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: AlohaCare Medicaid |
$721.26
|
| Rate for Payer: AlohaCare Medicare |
$656.98
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Devoted Health Medicare |
$722.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$656.98
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$788.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$788.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$788.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$721.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$656.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$721.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$656.98
|
|
