|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$758.16 |
| Max. Negotiated Rate |
$1,229.10 |
| Rate for Payer: AlohaCare Medicaid |
$850.77
|
| Rate for Payer: AlohaCare Medicare |
$798.13
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Devoted Health Medicare |
$877.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$798.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$758.16
|
| Rate for Payer: Health Management Network Commercial |
$1,229.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$957.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$957.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$957.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$850.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$798.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$850.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$798.13
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$291.98 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: AlohaCare Medicaid |
$384.31
|
| Rate for Payer: AlohaCare Medicare |
$356.83
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Devoted Health Medicare |
$392.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.98
|
| Rate for Payer: Health Management Network Commercial |
$551.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$384.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.83
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 54344
|
| Min. Negotiated Rate |
$849.77 |
| Max. Negotiated Rate |
$1,385.50 |
| Rate for Payer: AlohaCare Medicaid |
$951.72
|
| Rate for Payer: AlohaCare Medicare |
$849.77
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Devoted Health Medicare |
$934.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$849.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$922.74
|
| Rate for Payer: Health Management Network Commercial |
$1,385.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,019.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$951.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$849.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$951.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$849.77
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: AlohaCare Medicaid |
$575.07
|
| Rate for Payer: AlohaCare Medicare |
$548.07
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Devoted Health Medicare |
$602.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$379.86
|
| Rate for Payer: Health Management Network Commercial |
$839.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$657.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$657.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$575.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$575.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.07
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$1,039.13
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$883.26 |
| Rate for Payer: AlohaCare Medicaid |
$323.16
|
| Rate for Payer: AlohaCare Medicare |
$316.18
|
| Rate for Payer: Cash Price |
$623.48
|
| Rate for Payer: Cash Price |
$623.48
|
| Rate for Payer: Devoted Health Medicare |
$347.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$323.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$482.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$323.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$883.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$323.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.18
|
| Rate for Payer: University Health Alliance Commercial |
$351.47
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$645.35
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$548.55 |
| Rate for Payer: AlohaCare Medicaid |
$215.81
|
| Rate for Payer: AlohaCare Medicare |
$199.39
|
| Rate for Payer: Cash Price |
$387.21
|
| Rate for Payer: Cash Price |
$387.21
|
| Rate for Payer: Devoted Health Medicare |
$219.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$215.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$332.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$215.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.72
|
| Rate for Payer: Health Management Network Commercial |
$548.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$215.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.39
|
| Rate for Payer: University Health Alliance Commercial |
$281.51
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$782.60 |
| Max. Negotiated Rate |
$1,624.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,114.48
|
| Rate for Payer: AlohaCare Medicare |
$1,028.52
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Devoted Health Medicare |
$1,131.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,028.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$782.60
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,234.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,234.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,234.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,114.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,028.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,114.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,028.52
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$8,109.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$918.06 |
| Max. Negotiated Rate |
$6,892.65 |
| Rate for Payer: AlohaCare Medicaid |
$4,737.60
|
| Rate for Payer: AlohaCare Medicare |
$4,294.00
|
| Rate for Payer: Cash Price |
$4,865.40
|
| Rate for Payer: Cash Price |
$4,865.40
|
| Rate for Payer: Devoted Health Medicare |
$4,723.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,294.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$918.06
|
| Rate for Payer: Health Management Network Commercial |
$6,892.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,152.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,152.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,152.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,737.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,294.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,737.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,294.00
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$1,838.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$848.12 |
| Max. Negotiated Rate |
$1,562.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,067.66
|
| Rate for Payer: AlohaCare Medicare |
$947.47
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Devoted Health Medicare |
$1,042.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$947.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$848.12
|
| Rate for Payer: Health Management Network Commercial |
$1,562.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,136.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,136.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,067.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$947.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,067.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$947.47
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$747.56 |
| Max. Negotiated Rate |
$1,217.20 |
| Rate for Payer: AlohaCare Medicaid |
$832.71
|
| Rate for Payer: AlohaCare Medicare |
$747.56
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Devoted Health Medicare |
$822.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$747.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$915.98
|
| Rate for Payer: Health Management Network Commercial |
$1,217.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$897.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$832.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$747.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$832.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$747.56
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$558.74 |
| Max. Negotiated Rate |
$1,618.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,111.72
|
| Rate for Payer: AlohaCare Medicare |
$1,043.46
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Devoted Health Medicare |
$1,147.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,043.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.74
|
| Rate for Payer: Health Management Network Commercial |
$1,618.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,252.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,252.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,252.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,111.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,043.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,111.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,043.46
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$598.52 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: AlohaCare Medicaid |
$800.94
|
| Rate for Payer: AlohaCare Medicare |
$716.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Devoted Health Medicare |
$788.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$716.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$598.52
|
| Rate for Payer: Health Management Network Commercial |
$1,171.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$859.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$859.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$800.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$716.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$800.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$716.40
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$4,731.56
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$145.63 |
| Max. Negotiated Rate |
$4,021.83 |
| Rate for Payer: AlohaCare Medicaid |
$171.81
|
| Rate for Payer: AlohaCare Medicare |
$145.63
|
| Rate for Payer: Cash Price |
$2,838.94
|
| Rate for Payer: Cash Price |
$2,838.94
|
| Rate for Payer: Devoted Health Medicare |
$160.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$264.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.81
|
| Rate for Payer: Health Management Network Commercial |
$4,021.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.63
|
| Rate for Payer: University Health Alliance Commercial |
$213.45
|
|
|
PR RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
HCPCS 49610
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: AlohaCare Medicaid |
$692.94
|
| Rate for Payer: AlohaCare Medicare |
$651.84
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Devoted Health Medicare |
$717.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$651.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$490.88
|
| Rate for Payer: Health Management Network Commercial |
$1,010.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$782.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$782.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$692.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$651.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$692.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$651.84
|
|
|
PR RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 49611
|
| Min. Negotiated Rate |
$525.46 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: AlohaCare Medicaid |
$614.09
|
| Rate for Payer: AlohaCare Medicare |
$584.07
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Devoted Health Medicare |
$642.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$584.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$525.46
|
| Rate for Payer: Health Management Network Commercial |
$895.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$700.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$700.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$614.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$584.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$614.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$584.07
|
|
|
PR RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
HCPCS 49621
|
| Min. Negotiated Rate |
$656.98 |
| Max. Negotiated Rate |
$1,064.20 |
| Rate for Payer: AlohaCare Medicaid |
$721.26
|
| Rate for Payer: AlohaCare Medicare |
$656.98
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Devoted Health Medicare |
$722.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$656.98
|
| Rate for Payer: Health Management Network Commercial |
$1,064.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$788.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$788.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$788.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$721.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$656.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$721.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$656.98
|
|
|
PR RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 49622
|
| Min. Negotiated Rate |
$813.62 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: AlohaCare Medicaid |
$889.02
|
| Rate for Payer: AlohaCare Medicare |
$813.62
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Devoted Health Medicare |
$894.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$813.62
|
| Rate for Payer: Health Management Network Commercial |
$1,319.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$976.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$976.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$889.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$813.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$889.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$813.62
|
|
|
PR RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 27695
|
| Min. Negotiated Rate |
$428.22 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: AlohaCare Medicaid |
$511.70
|
| Rate for Payer: AlohaCare Medicare |
$479.57
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Devoted Health Medicare |
$527.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$479.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$428.22
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$575.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$575.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$479.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$479.57
|
|
|
PR RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27652
|
| Min. Negotiated Rate |
$618.02 |
| Max. Negotiated Rate |
$1,007.25 |
| Rate for Payer: AlohaCare Medicaid |
$696.51
|
| Rate for Payer: AlohaCare Medicare |
$627.05
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Devoted Health Medicare |
$689.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$627.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.02
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$696.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.05
|
|
|
PR RPR RECRT FEM HRNA INCARCERATED
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 49557
|
| Min. Negotiated Rate |
$458.38 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: AlohaCare Medicaid |
$719.20
|
| Rate for Payer: AlohaCare Medicare |
$680.43
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Devoted Health Medicare |
$748.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$680.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$458.38
|
| Rate for Payer: Health Management Network Commercial |
$1,046.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$816.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$816.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$816.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$719.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$680.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$719.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$680.43
|
|
|
PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 49520
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: AlohaCare Medicaid |
$632.99
|
| Rate for Payer: AlohaCare Medicare |
$599.28
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Devoted Health Medicare |
$659.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$599.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$522.34
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$719.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$719.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$719.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$599.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$632.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$599.28
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$449.28 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$713.60
|
| Rate for Payer: AlohaCare Medicare |
$673.28
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$740.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$673.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.28
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$807.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$807.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$807.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$713.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$673.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$713.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$673.28
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$453.44 |
| Max. Negotiated Rate |
$1,068.45 |
| Rate for Payer: AlohaCare Medicaid |
$733.10
|
| Rate for Payer: AlohaCare Medicare |
$692.55
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Devoted Health Medicare |
$761.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$453.44
|
| Rate for Payer: Health Management Network Commercial |
$1,068.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$831.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$831.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$733.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$733.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.55
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$978.35 |
| Rate for Payer: AlohaCare Medicaid |
$669.63
|
| Rate for Payer: AlohaCare Medicare |
$624.18
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Devoted Health Medicare |
$686.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$624.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$465.92
|
| Rate for Payer: Health Management Network Commercial |
$978.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$749.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$749.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$669.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$624.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$669.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$624.18
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$565.76 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: AlohaCare Medicaid |
$671.98
|
| Rate for Payer: AlohaCare Medicare |
$617.29
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Devoted Health Medicare |
$679.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$565.76
|
| Rate for Payer: Health Management Network Commercial |
$984.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$740.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$740.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$671.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$671.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.29
|
|
