|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$298.24
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: AlohaCare Medicaid |
$93.15
|
| Rate for Payer: AlohaCare Medicare |
$83.83
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Devoted Health Medicare |
$92.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.98
|
| Rate for Payer: Health Management Network Commercial |
$253.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.83
|
| Rate for Payer: University Health Alliance Commercial |
$101.92
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$60.92
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: AlohaCare Medicaid |
$24.45
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$36.55
|
| Rate for Payer: Cash Price |
$36.55
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.66
|
| Rate for Payer: Health Management Network Commercial |
$51.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$28.94
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$547.35
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$152.89 |
| Max. Negotiated Rate |
$465.25 |
| Rate for Payer: AlohaCare Medicaid |
$180.56
|
| Rate for Payer: AlohaCare Medicare |
$152.89
|
| Rate for Payer: Cash Price |
$328.41
|
| Rate for Payer: Cash Price |
$328.41
|
| Rate for Payer: Devoted Health Medicare |
$168.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.14
|
| Rate for Payer: Health Management Network Commercial |
$465.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.89
|
| Rate for Payer: University Health Alliance Commercial |
$224.47
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: AlohaCare Medicaid |
$40.94
|
| Rate for Payer: AlohaCare Medicare |
$35.48
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.81
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.48
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$558.45 |
| Rate for Payer: AlohaCare Medicaid |
$387.73
|
| Rate for Payer: AlohaCare Medicare |
$337.30
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Devoted Health Medicare |
$371.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.72
|
| Rate for Payer: Health Management Network Commercial |
$558.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$404.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$404.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$404.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$387.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$387.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.30
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$105.39 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: AlohaCare Medicaid |
$121.58
|
| Rate for Payer: AlohaCare Medicare |
$105.39
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Devoted Health Medicare |
$115.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.54
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.39
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: AlohaCare Medicaid |
$133.72
|
| Rate for Payer: AlohaCare Medicare |
$116.03
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Devoted Health Medicare |
$127.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.35
|
| Rate for Payer: Health Management Network Commercial |
$192.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.03
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$101.29 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$116.72
|
| Rate for Payer: AlohaCare Medicare |
$101.29
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$111.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.92
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.29
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$307.11 |
| Max. Negotiated Rate |
$491.30 |
| Rate for Payer: AlohaCare Medicaid |
$336.12
|
| Rate for Payer: AlohaCare Medicare |
$307.11
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Devoted Health Medicare |
$337.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.11
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$336.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$336.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.11
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$352.52 |
| Max. Negotiated Rate |
$575.45 |
| Rate for Payer: AlohaCare Medicaid |
$397.25
|
| Rate for Payer: AlohaCare Medicare |
$352.52
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Devoted Health Medicare |
$387.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$352.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.45
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$423.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$423.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$397.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$352.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$397.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$352.52
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Health Management Network Commercial |
$1,419.50
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Health Management Network Commercial |
$1,419.50
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$1,230.32 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,230.32
|
| Rate for Payer: Health Management Network Commercial |
$1,419.50
|
|
|
PR SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 15878
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Health Management Network Commercial |
$1,419.50
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$85.08 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$85.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$85.08
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$1,651.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$568.36 |
| Max. Negotiated Rate |
$1,403.35 |
| Rate for Payer: AlohaCare Medicaid |
$970.11
|
| Rate for Payer: AlohaCare Medicare |
$854.94
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Devoted Health Medicare |
$940.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$854.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$568.36
|
| Rate for Payer: Health Management Network Commercial |
$1,403.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,025.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,025.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,025.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$970.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$854.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$970.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$854.94
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$3,692.50
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$297.75 |
| Max. Negotiated Rate |
$3,138.62 |
| Rate for Payer: AlohaCare Medicaid |
$340.13
|
| Rate for Payer: AlohaCare Medicare |
$297.75
|
| Rate for Payer: Cash Price |
$2,215.50
|
| Rate for Payer: Cash Price |
$2,215.50
|
| Rate for Payer: Devoted Health Medicare |
$327.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$340.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$544.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$340.13
|
| Rate for Payer: Health Management Network Commercial |
$3,138.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$357.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$340.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.75
|
| Rate for Payer: University Health Alliance Commercial |
$545.00
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$3,684.06
|
|
|
Service Code
|
HCPCS 36254
|
| Min. Negotiated Rate |
$344.57 |
| Max. Negotiated Rate |
$3,131.45 |
| Rate for Payer: AlohaCare Medicaid |
$392.24
|
| Rate for Payer: AlohaCare Medicare |
$344.57
|
| Rate for Payer: Cash Price |
$2,210.44
|
| Rate for Payer: Cash Price |
$2,210.44
|
| Rate for Payer: Devoted Health Medicare |
$379.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$392.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$618.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$344.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$392.24
|
| Rate for Payer: Health Management Network Commercial |
$3,131.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$413.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$413.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$392.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$344.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$392.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$344.57
|
| Rate for Payer: University Health Alliance Commercial |
$524.03
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$829.20
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$267.02 |
| Max. Negotiated Rate |
$704.82 |
| Rate for Payer: AlohaCare Medicaid |
$347.66
|
| Rate for Payer: AlohaCare Medicare |
$307.87
|
| Rate for Payer: Cash Price |
$497.52
|
| Rate for Payer: Cash Price |
$497.52
|
| Rate for Payer: Devoted Health Medicare |
$338.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$347.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$534.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$347.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$267.02
|
| Rate for Payer: Health Management Network Commercial |
$704.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$369.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$347.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$347.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.87
|
| Rate for Payer: University Health Alliance Commercial |
$452.88
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 29828
|
| Min. Negotiated Rate |
$852.50 |
| Max. Negotiated Rate |
$1,375.30 |
| Rate for Payer: AlohaCare Medicaid |
$943.87
|
| Rate for Payer: AlohaCare Medicare |
$852.50
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Devoted Health Medicare |
$937.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$852.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$890.24
|
| Rate for Payer: Health Management Network Commercial |
$1,375.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,023.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,023.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,023.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$943.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$852.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$943.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$852.50
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 29806
|
| Min. Negotiated Rate |
$965.90 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,090.48
|
| Rate for Payer: AlohaCare Medicare |
$982.44
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Devoted Health Medicare |
$1,080.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$982.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$965.90
|
| Rate for Payer: Health Management Network Commercial |
$1,587.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,178.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,178.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,178.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,090.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$982.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,090.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$982.44
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 29824
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: AlohaCare Medicaid |
$708.33
|
| Rate for Payer: AlohaCare Medicare |
$653.61
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Devoted Health Medicare |
$718.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$653.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$591.50
|
| Rate for Payer: Health Management Network Commercial |
$1,033.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$784.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$784.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$784.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$708.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$653.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$708.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$653.61
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 29822
|
| Min. Negotiated Rate |
$529.12 |
| Max. Negotiated Rate |
$831.30 |
| Rate for Payer: AlohaCare Medicaid |
$568.81
|
| Rate for Payer: AlohaCare Medicare |
$529.12
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Devoted Health Medicare |
$582.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$529.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$643.24
|
| Rate for Payer: Health Management Network Commercial |
$831.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$634.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$529.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$568.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$529.12
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB
|
Professional
|
Both
|
$1,054.00
|
|
|
Service Code
|
HCPCS 29819
|
| Min. Negotiated Rate |
$562.74 |
| Max. Negotiated Rate |
$895.90 |
| Rate for Payer: AlohaCare Medicaid |
$614.70
|
| Rate for Payer: AlohaCare Medicare |
$562.74
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Devoted Health Medicare |
$619.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$562.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$655.98
|
| Rate for Payer: Health Management Network Commercial |
$895.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$675.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$675.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$614.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$614.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.74
|
|
