|
PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 23333
|
| Min. Negotiated Rate |
$472.49 |
| Max. Negotiated Rate |
$732.70 |
| Rate for Payer: AlohaCare Medicaid |
$500.37
|
| Rate for Payer: AlohaCare Medicare |
$472.49
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Devoted Health Medicare |
$519.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.49
|
| Rate for Payer: Health Management Network Commercial |
$732.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$566.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$500.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$500.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.49
|
|
|
PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Professional
|
Both
|
$233.10
|
|
|
Service Code
|
HCPCS 33286
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$198.13 |
| Rate for Payer: AlohaCare Medicaid |
$82.29
|
| Rate for Payer: AlohaCare Medicare |
$71.68
|
| Rate for Payer: Cash Price |
$139.86
|
| Rate for Payer: Cash Price |
$139.86
|
| Rate for Payer: Devoted Health Medicare |
$78.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.48
|
| Rate for Payer: Health Management Network Commercial |
$198.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.68
|
| Rate for Payer: University Health Alliance Commercial |
$112.33
|
|
|
PR REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$26.92
|
|
|
Service Code
|
HCPCS 15853
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$22.88 |
| Rate for Payer: AlohaCare Medicaid |
$13.19
|
| Rate for Payer: AlohaCare Medicare |
$15.00
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Devoted Health Medicare |
$16.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.00
|
| Rate for Payer: Health Management Network Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.00
|
|
|
PR REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA
|
Professional
|
Both
|
$103.50
|
|
|
Service Code
|
HCPCS 15851
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$87.97 |
| Rate for Payer: AlohaCare Medicaid |
$66.78
|
| Rate for Payer: AlohaCare Medicare |
$59.14
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Devoted Health Medicare |
$65.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$87.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.14
|
| Rate for Payer: University Health Alliance Commercial |
$51.95
|
|
|
PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
HCPCS 11971
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: AlohaCare Medicaid |
$578.09
|
| Rate for Payer: AlohaCare Medicare |
$531.21
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Devoted Health Medicare |
$584.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$534.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$531.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.50
|
| Rate for Payer: Health Management Network Commercial |
$844.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$637.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$578.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$531.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$578.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$531.21
|
|
|
PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 49422
|
| Min. Negotiated Rate |
$193.64 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: AlohaCare Medicaid |
$213.23
|
| Rate for Payer: AlohaCare Medicare |
$193.64
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Devoted Health Medicare |
$213.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$302.64
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$213.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$213.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.64
|
|
|
PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL
|
Professional
|
Both
|
$1,934.08
|
|
|
Service Code
|
HCPCS 50385
|
| Min. Negotiated Rate |
$187.29 |
| Max. Negotiated Rate |
$1,643.97 |
| Rate for Payer: AlohaCare Medicaid |
$211.16
|
| Rate for Payer: AlohaCare Medicare |
$187.29
|
| Rate for Payer: Cash Price |
$1,160.45
|
| Rate for Payer: Cash Price |
$1,160.45
|
| Rate for Payer: Devoted Health Medicare |
$206.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$211.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$341.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$211.16
|
| Rate for Payer: Health Management Network Commercial |
$1,643.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$224.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.29
|
| Rate for Payer: University Health Alliance Commercial |
$281.93
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 33227
|
| Min. Negotiated Rate |
$297.33 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: AlohaCare Medicaid |
$333.90
|
| Rate for Payer: AlohaCare Medicare |
$297.33
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Devoted Health Medicare |
$327.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.33
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$333.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$333.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.33
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 33228
|
| Min. Negotiated Rate |
$310.03 |
| Max. Negotiated Rate |
$506.60 |
| Rate for Payer: AlohaCare Medicaid |
$348.41
|
| Rate for Payer: AlohaCare Medicare |
$310.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Devoted Health Medicare |
$341.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.03
|
| Rate for Payer: Health Management Network Commercial |
$506.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$348.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$348.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.03
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 33229
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$531.25 |
| Rate for Payer: AlohaCare Medicaid |
$366.55
|
| Rate for Payer: AlohaCare Medicare |
$324.19
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Devoted Health Medicare |
$356.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.19
|
| Rate for Payer: Health Management Network Commercial |
$531.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$389.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$389.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$366.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$366.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.19
|
|
|
PR RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Professional
|
Both
|
$953.21
|
|
|
Service Code
|
HCPCS 50200
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$810.23 |
| Rate for Payer: AlohaCare Medicaid |
$125.78
|
| Rate for Payer: AlohaCare Medicare |
$110.23
|
| Rate for Payer: Cash Price |
$571.93
|
| Rate for Payer: Cash Price |
$571.93
|
| Rate for Payer: Devoted Health Medicare |
$121.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$197.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.88
|
| Rate for Payer: Health Management Network Commercial |
$810.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.23
|
|
|
PR RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$683.85
|
|
|
Service Code
|
HCPCS 50551
|
| Min. Negotiated Rate |
$234.52 |
| Max. Negotiated Rate |
$581.27 |
| Rate for Payer: AlohaCare Medicaid |
$290.19
|
| Rate for Payer: AlohaCare Medicare |
$257.09
|
| Rate for Payer: Cash Price |
$410.31
|
| Rate for Payer: Cash Price |
$410.31
|
| Rate for Payer: Devoted Health Medicare |
$282.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$290.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$451.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$290.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.52
|
| Rate for Payer: Health Management Network Commercial |
$581.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$308.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.09
|
| Rate for Payer: University Health Alliance Commercial |
$382.26
|
|
|
PR REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 49002
|
| Min. Negotiated Rate |
$490.62 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,024.42
|
| Rate for Payer: AlohaCare Medicare |
$949.54
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Devoted Health Medicare |
$1,044.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$490.62
|
| Rate for Payer: Health Management Network Commercial |
$1,491.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,024.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,024.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.54
|
|
|
PR REPAIR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$807.04 |
| Max. Negotiated Rate |
$2,031.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,404.49
|
| Rate for Payer: AlohaCare Medicare |
$1,281.10
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Cash Price |
$1,434.00
|
| Rate for Payer: Devoted Health Medicare |
$1,409.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,281.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$807.04
|
| Rate for Payer: Health Management Network Commercial |
$2,031.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,537.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,537.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,537.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,404.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,281.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,404.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,281.10
|
|
|
PR REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$567.06 |
| Max. Negotiated Rate |
$1,134.75 |
| Rate for Payer: AlohaCare Medicaid |
$782.63
|
| Rate for Payer: AlohaCare Medicare |
$722.01
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Devoted Health Medicare |
$794.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$722.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$567.06
|
| Rate for Payer: Health Management Network Commercial |
$1,134.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$866.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$866.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$866.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$782.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$722.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$782.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$722.01
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$587.86 |
| Max. Negotiated Rate |
$1,282.65 |
| Rate for Payer: AlohaCare Medicaid |
$890.30
|
| Rate for Payer: AlohaCare Medicare |
$811.10
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Devoted Health Medicare |
$892.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$811.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$587.86
|
| Rate for Payer: Health Management Network Commercial |
$1,282.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$973.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$973.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$973.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$890.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$811.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$890.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$811.10
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$1,118.60 |
| Rate for Payer: AlohaCare Medicaid |
$762.55
|
| Rate for Payer: AlohaCare Medicare |
$703.27
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Devoted Health Medicare |
$773.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$703.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$573.56
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$843.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$843.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$843.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$762.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$703.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$762.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$703.27
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$885.35 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: AlohaCare Medicaid |
$950.80
|
| Rate for Payer: AlohaCare Medicare |
$885.35
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Devoted Health Medicare |
$973.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$885.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$919.10
|
| Rate for Payer: Health Management Network Commercial |
$1,394.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,062.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,062.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$950.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$885.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$950.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$885.35
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$863.20 |
| Max. Negotiated Rate |
$1,405.90 |
| Rate for Payer: AlohaCare Medicaid |
$953.44
|
| Rate for Payer: AlohaCare Medicare |
$883.61
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Devoted Health Medicare |
$971.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$883.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$863.20
|
| Rate for Payer: Health Management Network Commercial |
$1,405.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,060.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,060.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,060.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$953.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$883.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$953.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$883.61
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$783.88
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$666.30 |
| Rate for Payer: AlohaCare Medicaid |
$284.59
|
| Rate for Payer: AlohaCare Medicare |
$236.40
|
| Rate for Payer: Cash Price |
$470.33
|
| Rate for Payer: Cash Price |
$470.33
|
| Rate for Payer: Devoted Health Medicare |
$260.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$284.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$439.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$236.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$284.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$282.62
|
| Rate for Payer: Health Management Network Commercial |
$666.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$283.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$283.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$284.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$284.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.40
|
| Rate for Payer: University Health Alliance Commercial |
$325.43
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$914.01
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$281.52 |
| Max. Negotiated Rate |
$776.91 |
| Rate for Payer: AlohaCare Medicaid |
$342.30
|
| Rate for Payer: AlohaCare Medicare |
$281.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Devoted Health Medicare |
$309.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$342.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$552.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$342.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.54
|
| Rate for Payer: Health Management Network Commercial |
$776.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$337.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.52
|
| Rate for Payer: University Health Alliance Commercial |
$391.59
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$721.77
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: AlohaCare Medicaid |
$248.26
|
| Rate for Payer: AlohaCare Medicare |
$207.37
|
| Rate for Payer: Cash Price |
$433.06
|
| Rate for Payer: Cash Price |
$433.06
|
| Rate for Payer: Devoted Health Medicare |
$228.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$248.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$382.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$248.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.92
|
| Rate for Payer: Health Management Network Commercial |
$613.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$248.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$248.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.37
|
| Rate for Payer: University Health Alliance Commercial |
$283.37
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$865.85
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$254.76 |
| Max. Negotiated Rate |
$735.97 |
| Rate for Payer: AlohaCare Medicaid |
$309.75
|
| Rate for Payer: AlohaCare Medicare |
$254.76
|
| Rate for Payer: Cash Price |
$519.51
|
| Rate for Payer: Cash Price |
$519.51
|
| Rate for Payer: Devoted Health Medicare |
$280.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$309.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$617.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$254.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$309.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.96
|
| Rate for Payer: Health Management Network Commercial |
$735.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$305.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$305.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$254.76
|
| Rate for Payer: University Health Alliance Commercial |
$353.92
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$308.35
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$101.38 |
| Max. Negotiated Rate |
$262.10 |
| Rate for Payer: AlohaCare Medicaid |
$125.74
|
| Rate for Payer: AlohaCare Medicare |
$101.38
|
| Rate for Payer: Cash Price |
$185.01
|
| Rate for Payer: Cash Price |
$185.01
|
| Rate for Payer: Devoted Health Medicare |
$111.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$195.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.86
|
| Rate for Payer: Health Management Network Commercial |
$262.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.38
|
| Rate for Payer: University Health Alliance Commercial |
$144.58
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$660.87
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$190.06 |
| Max. Negotiated Rate |
$561.74 |
| Rate for Payer: AlohaCare Medicaid |
$240.44
|
| Rate for Payer: AlohaCare Medicare |
$204.09
|
| Rate for Payer: Cash Price |
$396.52
|
| Rate for Payer: Cash Price |
$396.52
|
| Rate for Payer: Devoted Health Medicare |
$224.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$240.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$372.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$240.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.06
|
| Rate for Payer: Health Management Network Commercial |
$561.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$244.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.09
|
| Rate for Payer: University Health Alliance Commercial |
$275.92
|
|
