|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: AlohaCare Medicaid |
$724.40
|
| Rate for Payer: AlohaCare Medicare |
$691.05
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Devoted Health Medicare |
$760.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$691.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$347.10
|
| Rate for Payer: Health Management Network Commercial |
$1,043.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$829.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$829.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$829.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$724.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$691.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$724.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$691.05
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$551.44
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$468.72 |
| Rate for Payer: AlohaCare Medicaid |
$193.53
|
| Rate for Payer: AlohaCare Medicare |
$179.53
|
| Rate for Payer: Cash Price |
$330.86
|
| Rate for Payer: Cash Price |
$330.86
|
| Rate for Payer: Devoted Health Medicare |
$197.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$193.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$300.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$193.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$156.78
|
| Rate for Payer: Health Management Network Commercial |
$468.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$215.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$193.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.53
|
| Rate for Payer: University Health Alliance Commercial |
$222.54
|
|
|
PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 0184T
|
| Min. Negotiated Rate |
$974.10 |
| Max. Negotiated Rate |
$974.10 |
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Health Management Network Commercial |
$974.10
|
|
|
PR RELEASE THENAR MUSCLE
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 26508
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: AlohaCare Medicaid |
$735.50
|
| Rate for Payer: AlohaCare Medicare |
$682.18
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Devoted Health Medicare |
$750.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$355.42
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$818.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$818.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$818.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$735.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$735.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.18
|
|
|
PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS 33223
|
| Min. Negotiated Rate |
$359.01 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: AlohaCare Medicaid |
$402.78
|
| Rate for Payer: AlohaCare Medicare |
$359.01
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Devoted Health Medicare |
$394.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.72
|
| Rate for Payer: Health Management Network Commercial |
$584.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.01
|
|
|
PR RELOCATION OF SKIN POCKET FOR PACEMAKER
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 33222
|
| Min. Negotiated Rate |
$310.29 |
| Max. Negotiated Rate |
$498.95 |
| Rate for Payer: AlohaCare Medicaid |
$343.38
|
| Rate for Payer: AlohaCare Medicare |
$310.29
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Devoted Health Medicare |
$341.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.04
|
| Rate for Payer: Health Management Network Commercial |
$498.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$343.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$343.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.29
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 93297 TC
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$111.35 |
| Rate for Payer: AlohaCare Medicaid |
$66.06
|
| Rate for Payer: AlohaCare Medicare |
$41.21
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Devoted Health Medicare |
$45.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.99
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.21
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 93297
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: AlohaCare Medicaid |
$66.06
|
| Rate for Payer: AlohaCare Medicare |
$66.22
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$72.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.99
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.22
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93297 26
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$66.06 |
| Rate for Payer: AlohaCare Medicaid |
$66.06
|
| Rate for Payer: AlohaCare Medicare |
$25.02
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.99
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.02
|
|
|
PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP
|
Professional
|
Both
|
$52.45
|
|
|
Service Code
|
HCPCS 93294
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: AlohaCare Medicaid |
$29.52
|
| Rate for Payer: AlohaCare Medicare |
$29.97
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Devoted Health Medicare |
$32.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.97
|
| Rate for Payer: Health Management Network Commercial |
$44.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.97
|
|
|
PR REM INTERROG PM/LDLS PM/IDS <90 D TECH REVIEW
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93296
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: AlohaCare Medicaid |
$24.28
|
| Rate for Payer: AlohaCare Medicare |
$35.89
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Devoted Health Medicare |
$39.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.35
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.89
|
|
|
PR REM INTERROG SCRMS <30 D PHYS/QHP
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 93298
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: AlohaCare Medicaid |
$113.29
|
| Rate for Payer: AlohaCare Medicare |
$114.27
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Devoted Health Medicare |
$125.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.27
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.27
|
|
|
PR REM INTERROG SCRMS <30 D PHYS/QHP
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93298 26
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: AlohaCare Medicaid |
$113.29
|
| Rate for Payer: AlohaCare Medicare |
$25.02
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$27.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.02
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.02
|
|
|
PR REM INTERROG SCRMS <30 D PHYS/QHP
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 93298 TC
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: AlohaCare Medicaid |
$113.29
|
| Rate for Payer: AlohaCare Medicare |
$89.25
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Devoted Health Medicare |
$98.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.25
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.25
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH
|
Professional
|
Both
|
$96.83
|
|
|
Service Code
|
HCPCS 99457
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: AlohaCare Medicaid |
$30.23
|
| Rate for Payer: AlohaCare Medicare |
$26.46
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Devoted Health Medicare |
$29.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.11
|
| Rate for Payer: Health Management Network Commercial |
$82.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.46
|
| Rate for Payer: University Health Alliance Commercial |
$37.28
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO
|
Professional
|
Both
|
$76.21
|
|
|
Service Code
|
HCPCS 99458
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$64.78 |
| Rate for Payer: AlohaCare Medicaid |
$30.23
|
| Rate for Payer: AlohaCare Medicare |
$26.46
|
| Rate for Payer: Cash Price |
$45.73
|
| Rate for Payer: Cash Price |
$45.73
|
| Rate for Payer: Devoted Health Medicare |
$29.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.37
|
| Rate for Payer: Health Management Network Commercial |
$64.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.46
|
| Rate for Payer: University Health Alliance Commercial |
$37.28
|
|
|
PR REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$24.15
|
|
|
Service Code
|
HCPCS G2010
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.96
|
| Rate for Payer: Health Management Network Commercial |
$20.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.10
|
|
|
PR REMOVAL ANAL SETON OTHER MARKER
|
Professional
|
Both
|
$545.54
|
|
|
Service Code
|
HCPCS 46030
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$463.71 |
| Rate for Payer: AlohaCare Medicaid |
$87.02
|
| Rate for Payer: AlohaCare Medicare |
$80.46
|
| Rate for Payer: Cash Price |
$327.32
|
| Rate for Payer: Cash Price |
$327.32
|
| Rate for Payer: Devoted Health Medicare |
$88.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$136.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.94
|
| Rate for Payer: Health Management Network Commercial |
$463.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.46
|
| Rate for Payer: University Health Alliance Commercial |
$115.00
|
|
|
PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I
|
Professional
|
Both
|
$900.27
|
|
|
Service Code
|
HCPCS 47537
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$765.23 |
| Rate for Payer: AlohaCare Medicaid |
$94.63
|
| Rate for Payer: AlohaCare Medicare |
$83.40
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Cash Price |
$540.16
|
| Rate for Payer: Devoted Health Medicare |
$91.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$148.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$462.02
|
| Rate for Payer: Health Management Network Commercial |
$765.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.40
|
| Rate for Payer: University Health Alliance Commercial |
$125.69
|
|
|
PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I
|
Professional
|
Both
|
$1,540.72
|
|
|
Service Code
|
HCPCS 47544
|
| Min. Negotiated Rate |
$131.51 |
| Max. Negotiated Rate |
$1,309.61 |
| Rate for Payer: AlohaCare Medicaid |
$150.14
|
| Rate for Payer: AlohaCare Medicare |
$131.51
|
| Rate for Payer: Cash Price |
$924.43
|
| Rate for Payer: Cash Price |
$924.43
|
| Rate for Payer: Devoted Health Medicare |
$144.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$308.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.14
|
| Rate for Payer: Health Management Network Commercial |
$1,309.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.51
|
| Rate for Payer: University Health Alliance Commercial |
$200.51
|
|
|
PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST
|
Professional
|
Both
|
$128.06
|
|
|
Service Code
|
HCPCS 29705
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$108.85 |
| Rate for Payer: AlohaCare Medicaid |
$44.75
|
| Rate for Payer: AlohaCare Medicare |
$40.52
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Devoted Health Medicare |
$44.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$69.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.54
|
| Rate for Payer: Health Management Network Commercial |
$108.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.52
|
| Rate for Payer: University Health Alliance Commercial |
$59.11
|
|
|
PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE
|
Professional
|
Both
|
$1,509.41
|
|
|
Service Code
|
HCPCS 21029
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$1,283.00 |
| Rate for Payer: AlohaCare Medicaid |
$653.49
|
| Rate for Payer: AlohaCare Medicare |
$586.81
|
| Rate for Payer: Cash Price |
$905.65
|
| Rate for Payer: Cash Price |
$905.65
|
| Rate for Payer: Devoted Health Medicare |
$645.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$653.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$995.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$586.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$653.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$477.36
|
| Rate for Payer: Health Management Network Commercial |
$1,283.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$704.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$704.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$704.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$586.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$586.81
|
| Rate for Payer: University Health Alliance Commercial |
$843.19
|
|
|
PR REMOVAL DEEP DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$115.27
|
|
|
Service Code
|
HCPCS 20701
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: AlohaCare Medicaid |
$63.14
|
| Rate for Payer: AlohaCare Medicare |
$53.33
|
| Rate for Payer: Cash Price |
$69.16
|
| Rate for Payer: Cash Price |
$69.16
|
| Rate for Payer: Devoted Health Medicare |
$58.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.33
|
| Rate for Payer: Health Management Network Commercial |
$97.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.33
|
|
|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$415.65 |
| Rate for Payer: AlohaCare Medicaid |
$125.64
|
| Rate for Payer: AlohaCare Medicare |
$106.63
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Devoted Health Medicare |
$117.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$415.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.63
|
| Rate for Payer: University Health Alliance Commercial |
$160.88
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$859.97
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$730.97 |
| Rate for Payer: AlohaCare Medicaid |
$362.04
|
| Rate for Payer: AlohaCare Medicare |
$339.51
|
| Rate for Payer: Cash Price |
$515.98
|
| Rate for Payer: Cash Price |
$515.98
|
| Rate for Payer: Devoted Health Medicare |
$373.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$362.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$549.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$362.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$302.38
|
| Rate for Payer: Health Management Network Commercial |
$730.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$362.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$362.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.51
|
| Rate for Payer: University Health Alliance Commercial |
$465.01
|
|
