|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$554.84 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: AlohaCare Medicaid |
$724.99
|
| Rate for Payer: AlohaCare Medicare |
$652.77
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Devoted Health Medicare |
$718.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.84
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$783.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$783.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$783.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$724.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$724.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.77
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: AlohaCare Medicaid |
$435.85
|
| Rate for Payer: AlohaCare Medicare |
$393.67
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Devoted Health Medicare |
$433.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$543.66
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.67
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$22,564.30
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$22,564.30 |
| Max. Negotiated Rate |
$22,564.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,564.30
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$22,564.30
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$22,564.30 |
| Max. Negotiated Rate |
$22,564.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,564.30
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$15,927.74
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$15,927.74 |
| Max. Negotiated Rate |
$15,927.74 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,927.74
|
|
|
PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Professional
|
Both
|
$882.93
|
|
|
Service Code
|
HCPCS 28111
|
| Min. Negotiated Rate |
$310.47 |
| Max. Negotiated Rate |
$750.49 |
| Rate for Payer: AlohaCare Medicaid |
$332.98
|
| Rate for Payer: AlohaCare Medicare |
$310.47
|
| Rate for Payer: Cash Price |
$529.76
|
| Rate for Payer: Cash Price |
$529.76
|
| Rate for Payer: Devoted Health Medicare |
$341.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$332.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$512.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$332.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$315.90
|
| Rate for Payer: Health Management Network Commercial |
$750.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.47
|
| Rate for Payer: University Health Alliance Commercial |
$433.60
|
|
|
PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4
|
Professional
|
Both
|
$907.58
|
|
|
Service Code
|
HCPCS 28112
|
| Min. Negotiated Rate |
$270.66 |
| Max. Negotiated Rate |
$771.44 |
| Rate for Payer: AlohaCare Medicaid |
$330.22
|
| Rate for Payer: AlohaCare Medicare |
$307.84
|
| Rate for Payer: Cash Price |
$544.55
|
| Rate for Payer: Cash Price |
$544.55
|
| Rate for Payer: Devoted Health Medicare |
$338.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$330.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$501.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$330.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.66
|
| Rate for Payer: Health Management Network Commercial |
$771.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$369.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$330.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$330.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.84
|
| Rate for Payer: University Health Alliance Commercial |
$412.24
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS
|
Professional
|
Both
|
$59.88
|
|
|
Service Code
|
HCPCS 98925
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$50.90 |
| Rate for Payer: AlohaCare Medicaid |
$23.14
|
| Rate for Payer: AlohaCare Medicare |
$19.79
|
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Devoted Health Medicare |
$21.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$50.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.79
|
| Rate for Payer: University Health Alliance Commercial |
$24.53
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS
|
Professional
|
Both
|
$84.89
|
|
|
Service Code
|
HCPCS 98926
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$72.16 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$29.90
|
| Rate for Payer: Cash Price |
$50.93
|
| Rate for Payer: Cash Price |
$50.93
|
| Rate for Payer: Devoted Health Medicare |
$32.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.43
|
| Rate for Payer: Health Management Network Commercial |
$72.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.90
|
| Rate for Payer: University Health Alliance Commercial |
$38.09
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS
|
Professional
|
Both
|
$111.48
|
|
|
Service Code
|
HCPCS 98927
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: AlohaCare Medicaid |
$46.66
|
| Rate for Payer: AlohaCare Medicare |
$40.15
|
| Rate for Payer: Cash Price |
$66.89
|
| Rate for Payer: Cash Price |
$66.89
|
| Rate for Payer: Devoted Health Medicare |
$44.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.61
|
| Rate for Payer: Health Management Network Commercial |
$94.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.15
|
| Rate for Payer: University Health Alliance Commercial |
$38.09
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS
|
Professional
|
Both
|
$134.47
|
|
|
Service Code
|
HCPCS 98928
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: AlohaCare Medicaid |
$58.80
|
| Rate for Payer: AlohaCare Medicare |
$50.26
|
| Rate for Payer: Cash Price |
$80.68
|
| Rate for Payer: Cash Price |
$80.68
|
| Rate for Payer: Devoted Health Medicare |
$55.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.25
|
| Rate for Payer: Health Management Network Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.26
|
| Rate for Payer: University Health Alliance Commercial |
$50.05
|
|
|
PR OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 27165
|
| Min. Negotiated Rate |
$1,031.42 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,398.91
|
| Rate for Payer: AlohaCare Medicare |
$1,263.13
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Devoted Health Medicare |
$1,389.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,263.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,031.42
|
| Rate for Payer: Health Management Network Commercial |
$2,036.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,515.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,515.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,515.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,398.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,263.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,398.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,263.13
|
|
|
PR OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 27454
|
| Min. Negotiated Rate |
$1,004.38 |
| Max. Negotiated Rate |
$1,924.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,318.67
|
| Rate for Payer: AlohaCare Medicare |
$1,183.54
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,183.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.38
|
| Rate for Payer: Health Management Network Commercial |
$1,924.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,420.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,420.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,420.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,318.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,183.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,318.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,183.54
|
|
|
PR OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 23480
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,238.45 |
| Rate for Payer: AlohaCare Medicaid |
$848.35
|
| Rate for Payer: AlohaCare Medicare |
$772.32
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Devoted Health Medicare |
$849.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$772.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$546.00
|
| Rate for Payer: Health Management Network Commercial |
$1,238.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$926.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$926.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$926.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$848.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$772.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$848.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$772.32
|
|
|
PR OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 23485
|
| Min. Negotiated Rate |
$752.44 |
| Max. Negotiated Rate |
$1,428.00 |
| Rate for Payer: AlohaCare Medicaid |
$979.44
|
| Rate for Payer: AlohaCare Medicare |
$877.33
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Devoted Health Medicare |
$965.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$877.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$752.44
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,052.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,052.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$979.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$877.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$979.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$877.33
|
|
|
PR OSTEOTOMY FIBULA
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 27707
|
| Min. Negotiated Rate |
$295.36 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$433.33
|
| Rate for Payer: AlohaCare Medicare |
$408.32
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$449.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$295.36
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$489.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$433.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$433.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.32
|
|
|
PR OSTEOTOMY METACARPAL EACH
|
Professional
|
Both
|
$1,307.00
|
|
|
Service Code
|
HCPCS 26565
|
| Min. Negotiated Rate |
$426.92 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: AlohaCare Medicaid |
$767.19
|
| Rate for Payer: AlohaCare Medicare |
$729.72
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Devoted Health Medicare |
$802.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.92
|
| Rate for Payer: Health Management Network Commercial |
$1,110.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$875.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$875.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$875.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$767.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$767.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.72
|
|
|
PR OSTEOTOMY RADIUS DISTAL THIRD
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 25350
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: AlohaCare Medicaid |
$707.61
|
| Rate for Payer: AlohaCare Medicare |
$640.23
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Devoted Health Medicare |
$704.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$640.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$544.96
|
| Rate for Payer: Health Management Network Commercial |
$1,034.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$768.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$768.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$768.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$707.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$640.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$707.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$640.23
|
|
|
PROSTHESIS PENILE 13MM MALLBLE
|
Facility
|
OP
|
$24,631.00
|
|
|
Service Code
|
HCPCS C2622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,635.61 |
| Max. Negotiated Rate |
$23,892.07 |
| Rate for Payer: AlohaCare Medicaid |
$12,315.50
|
| Rate for Payer: AlohaCare Medicare |
$7,635.61
|
| Rate for Payer: Cash Price |
$14,778.60
|
| Rate for Payer: Devoted Health Medicare |
$8,374.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,635.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17,241.70
|
| Rate for Payer: Health Management Network Commercial |
$20,936.35
|
| Rate for Payer: Humana Medicare |
$7,635.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$22,167.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12,561.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,635.61
|
| Rate for Payer: MDX Hawaii PPO |
$23,892.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,635.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,635.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,635.61
|
| Rate for Payer: University Health Alliance Commercial |
$13,793.36
|
|
|
PROSTHESIS PENILE 13MM MALLBLE
|
Facility
|
IP
|
$24,631.00
|
|
|
Service Code
|
HCPCS C2622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,793.36 |
| Max. Negotiated Rate |
$23,892.07 |
| Rate for Payer: Cash Price |
$14,778.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17,241.70
|
| Rate for Payer: Health Management Network Commercial |
$20,936.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$22,167.90
|
| Rate for Payer: MDX Hawaii PPO |
$23,892.07
|
| Rate for Payer: University Health Alliance Commercial |
$13,793.36
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicaid |
$33.00
|
| Rate for Payer: AlohaCare Medicare |
$20.46
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$11.22
|
| Rate for Payer: Devoted Health Medicare |
$22.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.70
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Humana Medicare |
$20.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.46
|
| Rate for Payer: University Health Alliance Commercial |
$24.05
|
| Rate for Payer: University Health Alliance Commercial |
$48.11
|
|
|
PROTECTOR ARM 1STEP STND 40433
|
Facility
|
OP
|
$163.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$81.50
|
| Rate for Payer: AlohaCare Medicare |
$50.53
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Devoted Health Medicare |
$55.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.85
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$50.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.53
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.53
|
| Rate for Payer: University Health Alliance Commercial |
$118.81
|
|
|
PROTECTOR ARM 1STEP STND 40433
|
Facility
|
IP
|
$163.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
PROTECTOR HEEL PREVALON
|
Facility
|
OP
|
$225.00
|
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: AlohaCare Medicaid |
$112.50
|
| Rate for Payer: AlohaCare Medicare |
$69.75
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Devoted Health Medicare |
$76.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.50
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Humana Medicare |
$69.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.75
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.75
|
| Rate for Payer: University Health Alliance Commercial |
$126.00
|
|
