|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$51.80
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$45.62 |
| Rate for Payer: AlohaCare Medicaid |
$16.98
|
| Rate for Payer: AlohaCare Medicare |
$15.17
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Devoted Health Medicare |
$16.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.56
|
| Rate for Payer: Health Management Network Commercial |
$44.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.17
|
| Rate for Payer: University Health Alliance Commercial |
$23.03
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$53.46
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: AlohaCare Medicaid |
$18.90
|
| Rate for Payer: AlohaCare Medicare |
$15.74
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Cash Price |
$32.08
|
| Rate for Payer: Devoted Health Medicare |
$17.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.24
|
| Rate for Payer: Health Management Network Commercial |
$45.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.74
|
| Rate for Payer: University Health Alliance Commercial |
$23.32
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$55.46
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$47.27 |
| Rate for Payer: AlohaCare Medicaid |
$20.04
|
| Rate for Payer: AlohaCare Medicare |
$16.88
|
| Rate for Payer: Cash Price |
$33.28
|
| Rate for Payer: Cash Price |
$33.28
|
| Rate for Payer: Devoted Health Medicare |
$18.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.36
|
| Rate for Payer: Health Management Network Commercial |
$47.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.88
|
| Rate for Payer: University Health Alliance Commercial |
$26.04
|
|
|
PR STRAPPING HIP
|
Professional
|
Both
|
$65.75
|
|
|
Service Code
|
HCPCS 29520
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$55.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.33
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network Commercial |
$55.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$24.43
|
|
|
PR STRAPPING KNEE
|
Professional
|
Both
|
$53.78
|
|
|
Service Code
|
HCPCS 29530
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: AlohaCare Medicaid |
$17.95
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$50.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.68
|
| Rate for Payer: Health Management Network Commercial |
$45.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$23.94
|
|
|
PR STRAPPING SHOULDER
|
Professional
|
Both
|
$53.78
|
|
|
Service Code
|
HCPCS 29240
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: AlohaCare Medicaid |
$17.95
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Cash Price |
$32.27
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.02
|
| Rate for Payer: Health Management Network Commercial |
$45.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$22.39
|
|
|
PR STRAPPING THORAX
|
Professional
|
Both
|
$59.10
|
|
|
Service Code
|
HCPCS 29200
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$52.94 |
| Rate for Payer: AlohaCare Medicaid |
$18.33
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$35.46
|
| Rate for Payer: Cash Price |
$35.46
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.68
|
| Rate for Payer: Health Management Network Commercial |
$50.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$24.94
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$35.98
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$42.89 |
| Rate for Payer: AlohaCare Medicaid |
$10.99
|
| Rate for Payer: AlohaCare Medicare |
$9.54
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Devoted Health Medicare |
$10.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.64
|
| Rate for Payer: Health Management Network Commercial |
$30.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.54
|
| Rate for Payer: University Health Alliance Commercial |
$14.71
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: AlohaCare Medicaid |
$25.73
|
| Rate for Payer: AlohaCare Medicare |
$22.81
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$25.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.81
|
| Rate for Payer: University Health Alliance Commercial |
$34.82
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$249.05 |
| Rate for Payer: AlohaCare Medicaid |
$171.24
|
| Rate for Payer: AlohaCare Medicare |
$141.30
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Devoted Health Medicare |
$155.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.30
|
| Rate for Payer: Health Management Network Commercial |
$249.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.30
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<
|
Professional
|
Both
|
$163.99
|
|
|
Service Code
|
HCPCS 11950
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$139.39 |
| Rate for Payer: AlohaCare Medicaid |
$51.99
|
| Rate for Payer: AlohaCare Medicare |
$43.96
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Devoted Health Medicare |
$48.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.58
|
| Rate for Payer: Health Management Network Commercial |
$139.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.96
|
| Rate for Payer: University Health Alliance Commercial |
$59.93
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC
|
Professional
|
Both
|
$319.10
|
|
|
Service Code
|
HCPCS 11954
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: AlohaCare Medicaid |
$111.53
|
| Rate for Payer: AlohaCare Medicare |
$94.61
|
| Rate for Payer: Cash Price |
$191.46
|
| Rate for Payer: Cash Price |
$191.46
|
| Rate for Payer: Devoted Health Medicare |
$104.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.48
|
| Rate for Payer: Health Management Network Commercial |
$271.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.61
|
| Rate for Payer: University Health Alliance Commercial |
$129.77
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC
|
Professional
|
Both
|
$217.14
|
|
|
Service Code
|
HCPCS 11951
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$184.57 |
| Rate for Payer: AlohaCare Medicaid |
$72.79
|
| Rate for Payer: AlohaCare Medicare |
$61.41
|
| Rate for Payer: Cash Price |
$130.28
|
| Rate for Payer: Cash Price |
$130.28
|
| Rate for Payer: Devoted Health Medicare |
$67.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$184.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.41
|
| Rate for Payer: University Health Alliance Commercial |
$84.36
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC
|
Professional
|
Both
|
$288.70
|
|
|
Service Code
|
HCPCS 11952
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$245.40 |
| Rate for Payer: AlohaCare Medicaid |
$102.20
|
| Rate for Payer: AlohaCare Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Devoted Health Medicare |
$95.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.94
|
| Rate for Payer: Health Management Network Commercial |
$245.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.36
|
| Rate for Payer: University Health Alliance Commercial |
$118.83
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$664.70
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: AlohaCare Medicaid |
$218.88
|
| Rate for Payer: AlohaCare Medicare |
$193.36
|
| Rate for Payer: Cash Price |
$398.82
|
| Rate for Payer: Cash Price |
$398.82
|
| Rate for Payer: Devoted Health Medicare |
$212.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$218.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$218.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$346.06
|
| Rate for Payer: Health Management Network Commercial |
$565.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.36
|
| Rate for Payer: University Health Alliance Commercial |
$257.54
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: AlohaCare Medicaid |
$54.23
|
| Rate for Payer: AlohaCare Medicare |
$47.23
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$51.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.23
|
| Rate for Payer: University Health Alliance Commercial |
$64.61
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$298.24
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: AlohaCare Medicaid |
$93.15
|
| Rate for Payer: AlohaCare Medicare |
$83.83
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Cash Price |
$178.94
|
| Rate for Payer: Devoted Health Medicare |
$92.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.98
|
| Rate for Payer: Health Management Network Commercial |
$253.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.83
|
| Rate for Payer: University Health Alliance Commercial |
$101.92
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$60.92
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: AlohaCare Medicaid |
$24.45
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$36.55
|
| Rate for Payer: Cash Price |
$36.55
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.66
|
| Rate for Payer: Health Management Network Commercial |
$51.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$28.94
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$547.35
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$152.89 |
| Max. Negotiated Rate |
$465.25 |
| Rate for Payer: AlohaCare Medicaid |
$180.56
|
| Rate for Payer: AlohaCare Medicare |
$152.89
|
| Rate for Payer: Cash Price |
$328.41
|
| Rate for Payer: Cash Price |
$328.41
|
| Rate for Payer: Devoted Health Medicare |
$168.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.14
|
| Rate for Payer: Health Management Network Commercial |
$465.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.89
|
| Rate for Payer: University Health Alliance Commercial |
$224.47
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: AlohaCare Medicaid |
$40.94
|
| Rate for Payer: AlohaCare Medicare |
$35.48
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.81
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.48
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$558.45 |
| Rate for Payer: AlohaCare Medicaid |
$387.73
|
| Rate for Payer: AlohaCare Medicare |
$337.30
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Devoted Health Medicare |
$371.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.72
|
| Rate for Payer: Health Management Network Commercial |
$558.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$404.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$404.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$404.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$387.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$387.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.30
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$105.39 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: AlohaCare Medicaid |
$121.58
|
| Rate for Payer: AlohaCare Medicare |
$105.39
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Devoted Health Medicare |
$115.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.54
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.39
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: AlohaCare Medicaid |
$133.72
|
| Rate for Payer: AlohaCare Medicare |
$116.03
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Devoted Health Medicare |
$127.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.35
|
| Rate for Payer: Health Management Network Commercial |
$192.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.03
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$101.29 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$116.72
|
| Rate for Payer: AlohaCare Medicare |
$101.29
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$111.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.92
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.29
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$307.11 |
| Max. Negotiated Rate |
$491.30 |
| Rate for Payer: AlohaCare Medicaid |
$336.12
|
| Rate for Payer: AlohaCare Medicare |
$307.11
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Devoted Health Medicare |
$337.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.11
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$368.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$336.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$336.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.11
|
|
