|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$2,766.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$1,237.60 |
| Max. Negotiated Rate |
$2,351.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,610.92
|
| Rate for Payer: AlohaCare Medicare |
$1,431.76
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Cash Price |
$1,659.60
|
| Rate for Payer: Devoted Health Medicare |
$1,574.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,431.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,237.60
|
| Rate for Payer: Health Management Network Commercial |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,718.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,718.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,718.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,610.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,431.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,610.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,431.76
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$323.76 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: AlohaCare Medicaid |
$365.69
|
| Rate for Payer: AlohaCare Medicare |
$323.76
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Devoted Health Medicare |
$356.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$323.76
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$388.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$388.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$388.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$323.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$365.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$323.76
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$336.03 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: AlohaCare Medicaid |
$379.42
|
| Rate for Payer: AlohaCare Medicare |
$336.03
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Devoted Health Medicare |
$369.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$336.03
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$403.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$403.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$336.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$336.03
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$348.54 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: AlohaCare Medicaid |
$395.45
|
| Rate for Payer: AlohaCare Medicare |
$348.54
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Devoted Health Medicare |
$383.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$348.54
|
| Rate for Payer: Health Management Network Commercial |
$573.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$418.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$418.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$348.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$348.54
|
|
|
PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$348.64
|
|
|
Service Code
|
HCPCS 32552
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$296.34 |
| Rate for Payer: AlohaCare Medicaid |
$158.44
|
| Rate for Payer: AlohaCare Medicare |
$149.85
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Devoted Health Medicare |
$164.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.44
|
| Rate for Payer: Health Management Network Commercial |
$296.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.85
|
| Rate for Payer: University Health Alliance Commercial |
$196.25
|
|
|
PR RMVL NFROS TUBE REQ FLUORO GUIDANCE
|
Professional
|
Both
|
$776.39
|
|
|
Service Code
|
HCPCS 50389
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$659.93 |
| Rate for Payer: AlohaCare Medicaid |
$51.86
|
| Rate for Payer: AlohaCare Medicare |
$44.90
|
| Rate for Payer: Cash Price |
$465.83
|
| Rate for Payer: Cash Price |
$465.83
|
| Rate for Payer: Devoted Health Medicare |
$49.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.86
|
| Rate for Payer: Health Management Network Commercial |
$659.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.90
|
| Rate for Payer: University Health Alliance Commercial |
$86.00
|
|
|
PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 49623
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: AlohaCare Medicaid |
$190.83
|
| Rate for Payer: AlohaCare Medicare |
$174.80
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Devoted Health Medicare |
$192.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$283.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.80
|
|
|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$496.05 |
| Max. Negotiated Rate |
$794.75 |
| Rate for Payer: AlohaCare Medicaid |
$546.19
|
| Rate for Payer: AlohaCare Medicare |
$496.05
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$545.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$496.05
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$595.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$595.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$546.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$496.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$546.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$496.05
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$232.36 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: AlohaCare Medicaid |
$260.16
|
| Rate for Payer: AlohaCare Medicare |
$232.36
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$255.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.78
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$278.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.36
|
|
|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$2,107.00
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$1,104.40 |
| Max. Negotiated Rate |
$1,790.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,226.98
|
| Rate for Payer: AlohaCare Medicare |
$1,104.40
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Devoted Health Medicare |
$1,214.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,251.90
|
| Rate for Payer: Health Management Network Commercial |
$1,790.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,325.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,325.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,325.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,226.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,226.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.40
|
|
|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$786.10 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: AlohaCare Medicare |
$786.10
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Devoted Health Medicare |
$864.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$786.10
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$943.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$943.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$943.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$786.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$786.10
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,829.19
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$212.42 |
| Max. Negotiated Rate |
$1,554.81 |
| Rate for Payer: AlohaCare Medicaid |
$242.97
|
| Rate for Payer: AlohaCare Medicare |
$212.42
|
| Rate for Payer: Cash Price |
$1,097.51
|
| Rate for Payer: Cash Price |
$1,097.51
|
| Rate for Payer: Devoted Health Medicare |
$233.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$242.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$385.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$242.97
|
| Rate for Payer: Health Management Network Commercial |
$1,554.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.42
|
| Rate for Payer: University Health Alliance Commercial |
$326.75
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$930.84 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: AlohaCare Medicare |
$930.84
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Devoted Health Medicare |
$1,023.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$930.84
|
| Rate for Payer: Health Management Network Commercial |
$1,514.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,117.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,117.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,117.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$930.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$930.84
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,014.88
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$862.65 |
| Rate for Payer: AlohaCare Medicaid |
$80.36
|
| Rate for Payer: AlohaCare Medicare |
$70.28
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Cash Price |
$608.93
|
| Rate for Payer: Devoted Health Medicare |
$77.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$80.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$80.36
|
| Rate for Payer: Health Management Network Commercial |
$862.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.28
|
| Rate for Payer: University Health Alliance Commercial |
$107.84
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$342.16 |
| Max. Negotiated Rate |
$974.10 |
| Rate for Payer: AlohaCare Medicaid |
$666.18
|
| Rate for Payer: AlohaCare Medicare |
$602.03
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Devoted Health Medicare |
$662.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$602.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.16
|
| Rate for Payer: Health Management Network Commercial |
$974.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$722.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$722.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$722.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$666.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$602.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$666.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$602.03
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$33.34
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: AlohaCare Medicaid |
$16.33
|
| Rate for Payer: AlohaCare Medicare |
$12.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Devoted Health Medicare |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network Commercial |
$28.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.97
|
| Rate for Payer: University Health Alliance Commercial |
$18.87
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$174.40
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$148.24 |
| Rate for Payer: AlohaCare Medicaid |
$82.52
|
| Rate for Payer: AlohaCare Medicare |
$73.46
|
| Rate for Payer: Cash Price |
$104.64
|
| Rate for Payer: Cash Price |
$104.64
|
| Rate for Payer: Devoted Health Medicare |
$80.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$148.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.46
|
| Rate for Payer: University Health Alliance Commercial |
$90.04
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$526.19
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$447.26 |
| Rate for Payer: AlohaCare Medicaid |
$307.26
|
| Rate for Payer: AlohaCare Medicare |
$300.68
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Devoted Health Medicare |
$330.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$300.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$262.08
|
| Rate for Payer: Health Management Network Commercial |
$447.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$360.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$360.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$307.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.68
|
|
|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$317.72 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: AlohaCare Medicaid |
$474.32
|
| Rate for Payer: AlohaCare Medicare |
$421.02
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Devoted Health Medicare |
$463.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$421.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.72
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$505.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$505.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$505.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$474.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$474.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.02
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$372.84 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: AlohaCare Medicaid |
$624.57
|
| Rate for Payer: AlohaCare Medicare |
$558.95
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Devoted Health Medicare |
$614.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$558.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$372.84
|
| Rate for Payer: Health Management Network Commercial |
$906.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$670.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$670.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$670.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$624.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$558.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$624.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$558.95
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$406.47
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$172.64 |
| Max. Negotiated Rate |
$375.96 |
| Rate for Payer: AlohaCare Medicaid |
$189.01
|
| Rate for Payer: AlohaCare Medicare |
$172.64
|
| Rate for Payer: Cash Price |
$243.88
|
| Rate for Payer: Cash Price |
$243.88
|
| Rate for Payer: Devoted Health Medicare |
$189.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$298.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.96
|
| Rate for Payer: Health Management Network Commercial |
$345.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.64
|
| Rate for Payer: University Health Alliance Commercial |
$234.91
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$301.77
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: AlohaCare Medicaid |
$136.17
|
| Rate for Payer: AlohaCare Medicare |
$125.73
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Devoted Health Medicare |
$138.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.34
|
| Rate for Payer: Health Management Network Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.73
|
| Rate for Payer: University Health Alliance Commercial |
$169.47
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$261.78
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$251.90 |
| Rate for Payer: AlohaCare Medicaid |
$101.67
|
| Rate for Payer: AlohaCare Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$157.07
|
| Rate for Payer: Cash Price |
$157.07
|
| Rate for Payer: Devoted Health Medicare |
$94.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.82
|
| Rate for Payer: Health Management Network Commercial |
$222.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.17
|
| Rate for Payer: University Health Alliance Commercial |
$110.49
|
|
|
PR RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 50580
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: AlohaCare Medicaid |
$595.61
|
| Rate for Payer: AlohaCare Medicare |
$521.92
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Devoted Health Medicare |
$574.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$521.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$467.22
|
| Rate for Payer: Health Management Network Commercial |
$867.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$626.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$626.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$626.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$595.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$521.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$595.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$521.92
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$1,696.60 |
| Max. Negotiated Rate |
$1,696.60 |
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Management Network Commercial |
$1,696.60
|
|
