|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$51.33
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: AlohaCare Medicaid |
$29.88
|
| Rate for Payer: AlohaCare Medicare |
$25.15
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Devoted Health Medicare |
$27.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.54
|
| Rate for Payer: Health Management Network Commercial |
$43.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.15
|
| Rate for Payer: University Health Alliance Commercial |
$39.97
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$864.04
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$734.43 |
| Rate for Payer: AlohaCare Medicaid |
$440.37
|
| Rate for Payer: AlohaCare Medicare |
$402.98
|
| Rate for Payer: Cash Price |
$518.42
|
| Rate for Payer: Cash Price |
$518.42
|
| Rate for Payer: Devoted Health Medicare |
$443.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$440.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$440.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$344.50
|
| Rate for Payer: Health Management Network Commercial |
$734.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$483.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$483.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$440.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$440.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.98
|
| Rate for Payer: University Health Alliance Commercial |
$570.53
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,196.46
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,016.99 |
| Rate for Payer: AlohaCare Medicaid |
$418.67
|
| Rate for Payer: AlohaCare Medicare |
$401.90
|
| Rate for Payer: Cash Price |
$717.88
|
| Rate for Payer: Cash Price |
$717.88
|
| Rate for Payer: Devoted Health Medicare |
$442.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$418.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$648.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$418.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.14
|
| Rate for Payer: Health Management Network Commercial |
$1,016.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$418.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$418.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.90
|
| Rate for Payer: University Health Alliance Commercial |
$549.35
|
|
|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$856.85
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$728.32 |
| Rate for Payer: AlohaCare Medicaid |
$326.24
|
| Rate for Payer: AlohaCare Medicare |
$303.92
|
| Rate for Payer: Cash Price |
$514.11
|
| Rate for Payer: Cash Price |
$514.11
|
| Rate for Payer: Devoted Health Medicare |
$334.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$326.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$497.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$326.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$274.30
|
| Rate for Payer: Health Management Network Commercial |
$728.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.92
|
| Rate for Payer: University Health Alliance Commercial |
$421.14
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$453.97
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: AlohaCare Medicaid |
$139.11
|
| Rate for Payer: AlohaCare Medicare |
$132.19
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Devoted Health Medicare |
$145.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$139.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.24
|
| Rate for Payer: Health Management Network Commercial |
$385.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.19
|
| Rate for Payer: University Health Alliance Commercial |
$172.62
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: AlohaCare Medicaid |
$225.31
|
| Rate for Payer: AlohaCare Medicare |
$202.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Devoted Health Medicare |
$222.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.98
|
| Rate for Payer: Health Management Network Commercial |
$321.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.28
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$410.30
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: AlohaCare Medicaid |
$133.74
|
| Rate for Payer: AlohaCare Medicare |
$123.57
|
| Rate for Payer: Cash Price |
$246.18
|
| Rate for Payer: Cash Price |
$246.18
|
| Rate for Payer: Devoted Health Medicare |
$135.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$201.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$348.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.57
|
| Rate for Payer: University Health Alliance Commercial |
$162.22
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$433.62
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$368.58 |
| Rate for Payer: AlohaCare Medicaid |
$155.87
|
| Rate for Payer: AlohaCare Medicare |
$147.90
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Cash Price |
$260.17
|
| Rate for Payer: Devoted Health Medicare |
$162.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$155.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$368.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.90
|
| Rate for Payer: University Health Alliance Commercial |
$201.87
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$403.04
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: AlohaCare Medicaid |
$131.77
|
| Rate for Payer: AlohaCare Medicare |
$119.42
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Devoted Health Medicare |
$131.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$202.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.74
|
| Rate for Payer: Health Management Network Commercial |
$342.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.42
|
| Rate for Payer: University Health Alliance Commercial |
$171.04
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$536.35 |
| Rate for Payer: AlohaCare Medicaid |
$367.94
|
| Rate for Payer: AlohaCare Medicare |
$337.96
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Devoted Health Medicare |
$371.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$203.58
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.96
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$625.43
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$531.62 |
| Rate for Payer: AlohaCare Medicaid |
$178.39
|
| Rate for Payer: AlohaCare Medicare |
$173.20
|
| Rate for Payer: Cash Price |
$375.26
|
| Rate for Payer: Cash Price |
$375.26
|
| Rate for Payer: Devoted Health Medicare |
$190.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$178.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$253.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$178.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$531.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$178.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.20
|
| Rate for Payer: University Health Alliance Commercial |
$229.54
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$88.02
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: AlohaCare Medicaid |
$32.51
|
| Rate for Payer: AlohaCare Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Devoted Health Medicare |
$29.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.48
|
| Rate for Payer: Health Management Network Commercial |
$74.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.76
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$33.56
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: AlohaCare Medicaid |
$18.16
|
| Rate for Payer: AlohaCare Medicare |
$19.18
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Devoted Health Medicare |
$21.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.82
|
| Rate for Payer: Health Management Network Commercial |
$28.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.18
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$268.03
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$77.59 |
| Max. Negotiated Rate |
$227.83 |
| Rate for Payer: AlohaCare Medicaid |
$91.24
|
| Rate for Payer: AlohaCare Medicare |
$77.59
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Devoted Health Medicare |
$85.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$143.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.02
|
| Rate for Payer: Health Management Network Commercial |
$227.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.59
|
| Rate for Payer: University Health Alliance Commercial |
$98.21
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: AlohaCare Medicaid |
$214.86
|
| Rate for Payer: AlohaCare Medicare |
$198.23
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Devoted Health Medicare |
$218.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$172.90
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$214.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.23
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,176.32
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$999.87 |
| Rate for Payer: AlohaCare Medicaid |
$435.82
|
| Rate for Payer: AlohaCare Medicare |
$402.16
|
| Rate for Payer: Cash Price |
$705.79
|
| Rate for Payer: Cash Price |
$705.79
|
| Rate for Payer: Devoted Health Medicare |
$442.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$435.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$668.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$435.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.74
|
| Rate for Payer: Health Management Network Commercial |
$999.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.16
|
| Rate for Payer: University Health Alliance Commercial |
$542.81
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$278.72 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: AlohaCare Medicaid |
$375.57
|
| Rate for Payer: AlohaCare Medicare |
$351.10
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Devoted Health Medicare |
$386.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$351.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.72
|
| Rate for Payer: Health Management Network Commercial |
$549.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$421.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$421.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$351.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$351.10
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$714.21
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$607.08 |
| Rate for Payer: AlohaCare Medicaid |
$153.36
|
| Rate for Payer: AlohaCare Medicare |
$146.08
|
| Rate for Payer: Cash Price |
$428.53
|
| Rate for Payer: Cash Price |
$428.53
|
| Rate for Payer: Devoted Health Medicare |
$160.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$233.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$607.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.08
|
| Rate for Payer: University Health Alliance Commercial |
$197.49
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$372.84 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: AlohaCare Medicaid |
$574.42
|
| Rate for Payer: AlohaCare Medicare |
$524.44
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Devoted Health Medicare |
$576.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$524.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$372.84
|
| Rate for Payer: Health Management Network Commercial |
$840.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$629.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$629.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$574.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$524.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$574.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$524.44
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: AlohaCare Medicaid |
$31.95
|
| Rate for Payer: AlohaCare Medicare |
$28.35
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.35
|
|
|
PR REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$205.19
|
|
|
Service Code
|
HCPCS 58301
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$174.41 |
| Rate for Payer: AlohaCare Medicaid |
$65.32
|
| Rate for Payer: AlohaCare Medicare |
$56.11
|
| Rate for Payer: Cash Price |
$123.11
|
| Rate for Payer: Cash Price |
$123.11
|
| Rate for Payer: Devoted Health Medicare |
$61.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.14
|
| Rate for Payer: Health Management Network Commercial |
$174.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.11
|
| Rate for Payer: University Health Alliance Commercial |
$80.61
|
|
|
PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$210.63
|
|
|
Service Code
|
HCPCS 11982
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$179.04 |
| Rate for Payer: AlohaCare Medicaid |
$72.04
|
| Rate for Payer: AlohaCare Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$126.38
|
| Rate for Payer: Cash Price |
$126.38
|
| Rate for Payer: Devoted Health Medicare |
$67.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.22
|
| Rate for Payer: Health Management Network Commercial |
$179.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.91
|
|
|
PR REMOVAL OF SUTURES
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS S0630
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.52
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
|
|
PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 33233
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: AlohaCare Medicaid |
$235.01
|
| Rate for Payer: AlohaCare Medicare |
$214.11
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Devoted Health Medicare |
$235.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.32
|
| Rate for Payer: Health Management Network Commercial |
$340.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$235.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.11
|
|
|
PR REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 33992
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: AlohaCare Medicaid |
$176.90
|
| Rate for Payer: AlohaCare Medicare |
$156.49
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Devoted Health Medicare |
$172.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.49
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.49
|
|
