|
PROTECTOR HEEL PREVALON
|
Facility
|
IP
|
$225.00
|
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.50
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: University Health Alliance Commercial |
$126.00
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: AlohaCare Medicaid |
$99.56
|
| Rate for Payer: AlohaCare Medicare |
$89.58
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Devoted Health Medicare |
$98.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.47
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.58
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,217.37
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$346.32 |
| Max. Negotiated Rate |
$1,034.76 |
| Rate for Payer: AlohaCare Medicaid |
$493.54
|
| Rate for Payer: AlohaCare Medicare |
$438.92
|
| Rate for Payer: Cash Price |
$730.42
|
| Rate for Payer: Cash Price |
$730.42
|
| Rate for Payer: Devoted Health Medicare |
$482.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$493.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$752.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$438.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$493.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$346.32
|
| Rate for Payer: Health Management Network Commercial |
$1,034.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$526.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$526.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$526.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$493.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$438.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$493.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$438.92
|
| Rate for Payer: University Health Alliance Commercial |
$637.48
|
|
|
PROVENA SOLO 3FR SINGLE LUMEN
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
HCPCS C1751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.60 |
| Max. Negotiated Rate |
$1,063.12 |
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
|
|
PROVENA SOLO 3FR SINGLE LUMEN
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
HCPCS C1751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.76 |
| Max. Negotiated Rate |
$1,063.12 |
| Rate for Payer: AlohaCare Medicaid |
$548.00
|
| Rate for Payer: AlohaCare Medicare |
$339.76
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Devoted Health Medicare |
$372.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,041.20
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Humana Medicare |
$339.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$558.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.76
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.76
|
| Rate for Payer: University Health Alliance Commercial |
$798.87
|
|
|
PROXIMAL BODY PTC ARS741702
|
Facility
|
OP
|
$13,112.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.72 |
| Max. Negotiated Rate |
$12,718.64 |
| Rate for Payer: AlohaCare Medicaid |
$6,556.00
|
| Rate for Payer: AlohaCare Medicare |
$4,064.72
|
| Rate for Payer: Cash Price |
$7,867.20
|
| Rate for Payer: Devoted Health Medicare |
$4,458.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,064.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,178.40
|
| Rate for Payer: Health Management Network Commercial |
$11,145.20
|
| Rate for Payer: Humana Medicare |
$4,064.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,800.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,687.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,064.72
|
| Rate for Payer: MDX Hawaii PPO |
$12,718.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,064.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,064.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,064.72
|
| Rate for Payer: University Health Alliance Commercial |
$7,342.72
|
|
|
PROXIMAL BODY PTC ARS741702
|
Facility
|
IP
|
$13,112.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,342.72 |
| Max. Negotiated Rate |
$12,718.64 |
| Rate for Payer: Cash Price |
$7,867.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,178.40
|
| Rate for Payer: Health Management Network Commercial |
$11,145.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,800.80
|
| Rate for Payer: MDX Hawaii PPO |
$12,718.64
|
| Rate for Payer: University Health Alliance Commercial |
$7,342.72
|
|
|
PROXIMAL OLECRANON PLATE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$713.00 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,150.00
|
| Rate for Payer: AlohaCare Medicare |
$713.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Devoted Health Medicare |
$782.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$713.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,610.00
|
| Rate for Payer: Health Management Network Commercial |
$1,955.00
|
| Rate for Payer: Humana Medicare |
$713.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,070.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,173.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$713.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,231.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$713.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$713.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$713.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,288.00
|
|
|
PROXIMAL OLECRANON PLATE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,610.00
|
| Rate for Payer: Health Management Network Commercial |
$1,955.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,070.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,231.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,288.00
|
|
|
PROXMAL HUMERUS 4 HOLE 627205
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,113.44 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,641.80
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
| Rate for Payer: University Health Alliance Commercial |
$2,113.44
|
|
|
PROXMAL HUMERUS 4 HOLE 627205
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.94 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,887.00
|
| Rate for Payer: AlohaCare Medicare |
$1,169.94
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Devoted Health Medicare |
$1,283.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,169.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,641.80
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Humana Medicare |
$1,169.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,924.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,169.94
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,169.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,169.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,169.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,113.44
|
|
|
PR PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$1,222.00
|
|
|
Service Code
|
HCPCS 42145
|
| Min. Negotiated Rate |
$622.38 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: AlohaCare Medicaid |
$718.47
|
| Rate for Payer: AlohaCare Medicare |
$622.38
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Devoted Health Medicare |
$684.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$671.32
|
| Rate for Payer: Health Management Network Commercial |
$1,038.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$746.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$746.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$718.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.38
|
|
|
PR PARATHYROID AUTOTRANSPLANTATION ADD-ON
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 60512
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: AlohaCare Medicaid |
$234.77
|
| Rate for Payer: AlohaCare Medicare |
$203.24
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Devoted Health Medicare |
$223.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.34
|
| Rate for Payer: Health Management Network Commercial |
$340.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.24
|
|
|
PR PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 60500
|
| Min. Negotiated Rate |
$808.34 |
| Max. Negotiated Rate |
$1,414.40 |
| Rate for Payer: AlohaCare Medicaid |
$972.70
|
| Rate for Payer: AlohaCare Medicare |
$880.82
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Devoted Health Medicare |
$968.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$880.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$808.34
|
| Rate for Payer: Health Management Network Commercial |
$1,414.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,056.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,056.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,056.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$972.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$880.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$972.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$880.82
|
|
|
PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1
|
Professional
|
Both
|
$135.87
|
|
|
Service Code
|
HCPCS 11055
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$115.49 |
| Rate for Payer: AlohaCare Medicaid |
$15.27
|
| Rate for Payer: AlohaCare Medicare |
$13.46
|
| Rate for Payer: Cash Price |
$81.52
|
| Rate for Payer: Cash Price |
$81.52
|
| Rate for Payer: Devoted Health Medicare |
$14.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.32
|
| Rate for Payer: Health Management Network Commercial |
$115.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.46
|
| Rate for Payer: University Health Alliance Commercial |
$16.47
|
|
|
PR PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4
|
Professional
|
Both
|
$156.28
|
|
|
Service Code
|
HCPCS 11056
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: AlohaCare Medicaid |
$21.60
|
| Rate for Payer: AlohaCare Medicare |
$19.42
|
| Rate for Payer: Cash Price |
$93.77
|
| Rate for Payer: Cash Price |
$93.77
|
| Rate for Payer: Devoted Health Medicare |
$21.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.86
|
| Rate for Payer: Health Management Network Commercial |
$132.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.42
|
| Rate for Payer: University Health Alliance Commercial |
$23.71
|
|
|
PR PARTIAL EXCISION BONE CLAVICLE
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 23180
|
| Min. Negotiated Rate |
$437.06 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: AlohaCare Medicaid |
$687.95
|
| Rate for Payer: AlohaCare Medicare |
$669.93
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Devoted Health Medicare |
$736.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.06
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$803.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$687.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$687.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.93
|
|
|
PR PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$1,277.99
|
|
|
Service Code
|
HCPCS 28120
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,086.29 |
| Rate for Payer: AlohaCare Medicaid |
$519.05
|
| Rate for Payer: AlohaCare Medicare |
$482.30
|
| Rate for Payer: Cash Price |
$766.79
|
| Rate for Payer: Cash Price |
$766.79
|
| Rate for Payer: Devoted Health Medicare |
$530.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$519.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$719.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$519.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$340.60
|
| Rate for Payer: Health Management Network Commercial |
$1,086.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$578.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$578.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$519.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.30
|
| Rate for Payer: University Health Alliance Commercial |
$674.05
|
|
|
PR PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 27640
|
| Min. Negotiated Rate |
$778.63 |
| Max. Negotiated Rate |
$1,245.25 |
| Rate for Payer: AlohaCare Medicaid |
$858.14
|
| Rate for Payer: AlohaCare Medicare |
$778.63
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Devoted Health Medicare |
$856.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$778.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$889.46
|
| Rate for Payer: Health Management Network Commercial |
$1,245.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$934.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$934.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$934.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$858.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$778.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$858.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$778.63
|
|
|
PR PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 26236
|
| Min. Negotiated Rate |
$322.40 |
| Max. Negotiated Rate |
$689.35 |
| Rate for Payer: AlohaCare Medicaid |
$471.19
|
| Rate for Payer: AlohaCare Medicare |
$436.30
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Devoted Health Medicare |
$479.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$436.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$322.40
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$523.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$523.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$471.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$436.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$471.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$436.30
|
|
|
PR PARTIAL HYMENECTOMY OR REVISION HYMENAL RING
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 56700
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: AlohaCare Medicaid |
$211.94
|
| Rate for Payer: AlohaCare Medicare |
$184.97
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$203.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.97
|
|
|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$889.32
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$330.45 |
| Max. Negotiated Rate |
$755.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.22
|
| Rate for Payer: AlohaCare Medicare |
$330.45
|
| Rate for Payer: Cash Price |
$533.59
|
| Rate for Payer: Cash Price |
$533.59
|
| Rate for Payer: Devoted Health Medicare |
$363.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$354.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$534.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$354.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$755.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.45
|
| Rate for Payer: University Health Alliance Commercial |
$452.51
|
|
|
PR PATCH/APPLICATION TESTS SPECIFY NUMBER TESTS
|
Professional
|
Both
|
$9.64
|
|
|
Service Code
|
HCPCS 95044
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: AlohaCare Medicaid |
$5.54
|
| Rate for Payer: AlohaCare Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Devoted Health Medicare |
$6.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.58
|
| Rate for Payer: Health Management Network Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.51
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.03
|
| Rate for Payer: Health Management Network Commercial |
$807.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR PCV15 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 90671
|
| Min. Negotiated Rate |
$269.31 |
| Max. Negotiated Rate |
$421.60 |
| Rate for Payer: AlohaCare Medicare |
$269.31
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Devoted Health Medicare |
$296.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.31
|
| Rate for Payer: Health Management Network Commercial |
$421.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.31
|
|
