|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 91034 26
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$238.29 |
| Rate for Payer: AlohaCare Medicaid |
$213.16
|
| Rate for Payer: AlohaCare Medicare |
$51.88
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$57.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.29
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.88
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$207.40
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$228.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.40
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.40
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 91037 TC
|
| Min. Negotiated Rate |
$154.19 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$154.19
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$169.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.19
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.19
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 91037 26
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: AlohaCare Medicaid |
$187.55
|
| Rate for Payer: AlohaCare Medicare |
$53.21
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$58.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.21
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$187.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.21
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 91035 TC
|
| Min. Negotiated Rate |
$473.96 |
| Max. Negotiated Rate |
$1,126.25 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$473.96
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Devoted Health Medicare |
$521.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$473.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$1,126.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$568.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$473.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$473.96
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 91035 26
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$511.07 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$87.33
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$96.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.33
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$475.05 |
| Max. Negotiated Rate |
$1,256.30 |
| Rate for Payer: AlohaCare Medicaid |
$511.07
|
| Rate for Payer: AlohaCare Medicare |
$561.28
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Devoted Health Medicare |
$617.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$561.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.05
|
| Rate for Payer: Health Management Network Commercial |
$1,256.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$673.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$673.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$673.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$561.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$561.28
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$1,926.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,323.27
|
| Rate for Payer: AlohaCare Medicare |
$1,224.90
|
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Devoted Health Medicare |
$1,347.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,224.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$1,926.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,469.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,469.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,469.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,323.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,224.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,323.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,224.90
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$1,946.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,336.28
|
| Rate for Payer: AlohaCare Medicare |
$1,238.26
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Devoted Health Medicare |
$1,362.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,238.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$537.94
|
| Rate for Payer: Health Management Network Commercial |
$1,946.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,485.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,485.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,336.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,238.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,336.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,238.26
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$521.56 |
| Max. Negotiated Rate |
$1,024.25 |
| Rate for Payer: AlohaCare Medicaid |
$704.39
|
| Rate for Payer: AlohaCare Medicare |
$670.29
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Devoted Health Medicare |
$737.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$670.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$521.56
|
| Rate for Payer: Health Management Network Commercial |
$1,024.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$804.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$804.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$704.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$670.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$704.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$670.29
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,339.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$427.44 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: AlohaCare Medicaid |
$779.82
|
| Rate for Payer: AlohaCare Medicare |
$737.22
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Devoted Health Medicare |
$810.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$737.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.44
|
| Rate for Payer: Health Management Network Commercial |
$1,138.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$884.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$884.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$779.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$737.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$779.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$737.22
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$700.44 |
| Max. Negotiated Rate |
$1,925.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.81
|
| Rate for Payer: AlohaCare Medicare |
$1,232.85
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Devoted Health Medicare |
$1,356.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,232.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$700.44
|
| Rate for Payer: Health Management Network Commercial |
$1,925.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,479.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,479.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,479.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,328.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,232.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,328.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,232.85
|
|
|
PR GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
HCPCS 43361
|
| Min. Negotiated Rate |
$1,695.98 |
| Max. Negotiated Rate |
$3,832.65 |
| Rate for Payer: AlohaCare Medicaid |
$2,631.14
|
| Rate for Payer: AlohaCare Medicare |
$2,424.95
|
| Rate for Payer: Cash Price |
$2,705.40
|
| Rate for Payer: Cash Price |
$2,705.40
|
| Rate for Payer: Devoted Health Medicare |
$2,667.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,424.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,695.98
|
| Rate for Payer: Health Management Network Commercial |
$3,832.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,909.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,909.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,909.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,631.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,424.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,631.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,424.95
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 91110 TC
|
| Min. Negotiated Rate |
$777.96 |
| Max. Negotiated Rate |
$1,853.85 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$777.96
|
| Rate for Payer: Cash Price |
$1,308.60
|
| Rate for Payer: Cash Price |
$1,308.60
|
| Rate for Payer: Devoted Health Medicare |
$855.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$777.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$1,853.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$933.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$933.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$933.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$777.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$777.96
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 91110 26
|
| Min. Negotiated Rate |
$122.59 |
| Max. Negotiated Rate |
$986.15 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$122.59
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Devoted Health Medicare |
$134.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.59
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$824.94 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: AlohaCare Medicaid |
$824.94
|
| Rate for Payer: AlohaCare Medicare |
$900.55
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Devoted Health Medicare |
$990.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$900.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$986.15
|
| Rate for Payer: Health Management Network Commercial |
$2,036.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,080.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,080.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,080.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$824.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$900.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$824.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$900.55
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,912.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,625.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,125.28
|
| Rate for Payer: AlohaCare Medicare |
$1,031.88
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Devoted Health Medicare |
$1,135.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,031.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$675.22
|
| Rate for Payer: Health Management Network Commercial |
$1,625.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,238.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,238.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,031.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,125.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,031.88
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,585.68
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$485.42 |
| Max. Negotiated Rate |
$1,347.83 |
| Rate for Payer: AlohaCare Medicaid |
$726.33
|
| Rate for Payer: AlohaCare Medicare |
$626.21
|
| Rate for Payer: Cash Price |
$951.41
|
| Rate for Payer: Cash Price |
$951.41
|
| Rate for Payer: Devoted Health Medicare |
$688.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$726.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,117.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$726.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$485.42
|
| Rate for Payer: Health Management Network Commercial |
$1,347.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$751.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$751.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$751.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$726.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$726.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.21
|
| Rate for Payer: University Health Alliance Commercial |
$826.66
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,374.96
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$456.04 |
| Max. Negotiated Rate |
$1,168.72 |
| Rate for Payer: AlohaCare Medicaid |
$601.44
|
| Rate for Payer: AlohaCare Medicare |
$522.89
|
| Rate for Payer: Cash Price |
$824.98
|
| Rate for Payer: Cash Price |
$824.98
|
| Rate for Payer: Devoted Health Medicare |
$575.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$601.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$917.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$601.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$456.04
|
| Rate for Payer: Health Management Network Commercial |
$1,168.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$601.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.89
|
| Rate for Payer: University Health Alliance Commercial |
$777.02
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,156.26
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$465.13 |
| Max. Negotiated Rate |
$982.82 |
| Rate for Payer: AlohaCare Medicaid |
$521.14
|
| Rate for Payer: AlohaCare Medicare |
$465.13
|
| Rate for Payer: Cash Price |
$693.76
|
| Rate for Payer: Cash Price |
$693.76
|
| Rate for Payer: Devoted Health Medicare |
$511.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$521.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$808.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$465.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$521.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$634.66
|
| Rate for Payer: Health Management Network Commercial |
$982.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$558.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$558.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$558.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$521.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$465.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$465.13
|
| Rate for Payer: University Health Alliance Commercial |
$598.47
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,226.58
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$485.57 |
| Max. Negotiated Rate |
$1,042.59 |
| Rate for Payer: AlohaCare Medicaid |
$532.69
|
| Rate for Payer: AlohaCare Medicare |
$485.57
|
| Rate for Payer: Cash Price |
$735.95
|
| Rate for Payer: Cash Price |
$735.95
|
| Rate for Payer: Devoted Health Medicare |
$534.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$532.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$790.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$485.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$532.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$628.94
|
| Rate for Payer: Health Management Network Commercial |
$1,042.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$582.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$582.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$532.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$485.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$532.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$485.57
|
| Rate for Payer: University Health Alliance Commercial |
$584.99
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$366.57
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$119.47 |
| Max. Negotiated Rate |
$311.58 |
| Rate for Payer: AlohaCare Medicaid |
$142.37
|
| Rate for Payer: AlohaCare Medicare |
$119.47
|
| Rate for Payer: Cash Price |
$219.94
|
| Rate for Payer: Cash Price |
$219.94
|
| Rate for Payer: Devoted Health Medicare |
$131.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$223.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.80
|
| Rate for Payer: Health Management Network Commercial |
$311.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.47
|
| Rate for Payer: University Health Alliance Commercial |
$165.42
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$375.18
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$318.90 |
| Rate for Payer: AlohaCare Medicaid |
$147.27
|
| Rate for Payer: AlohaCare Medicare |
$124.00
|
| Rate for Payer: Cash Price |
$225.11
|
| Rate for Payer: Cash Price |
$225.11
|
| Rate for Payer: Devoted Health Medicare |
$136.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$147.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$195.26
|
| Rate for Payer: Health Management Network Commercial |
$318.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.00
|
| Rate for Payer: University Health Alliance Commercial |
$169.87
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$462.29 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: AlohaCare Medicaid |
$496.03
|
| Rate for Payer: AlohaCare Medicare |
$462.29
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Devoted Health Medicare |
$508.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$518.44
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$554.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$554.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$554.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$496.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$496.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.29
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$54.79
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$46.57 |
| Rate for Payer: AlohaCare Medicaid |
$24.07
|
| Rate for Payer: AlohaCare Medicare |
$24.47
|
| Rate for Payer: Cash Price |
$32.87
|
| Rate for Payer: Cash Price |
$32.87
|
| Rate for Payer: Devoted Health Medicare |
$26.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.07
|
| Rate for Payer: Health Management Network Commercial |
$46.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.47
|
| Rate for Payer: University Health Alliance Commercial |
$29.44
|
|
