|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$1,407.49
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,196.37 |
| Rate for Payer: AlohaCare Medicaid |
$171.39
|
| Rate for Payer: AlohaCare Medicare |
$149.18
|
| Rate for Payer: Cash Price |
$844.49
|
| Rate for Payer: Cash Price |
$844.49
|
| Rate for Payer: Devoted Health Medicare |
$164.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$319.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.46
|
| Rate for Payer: Health Management Network Commercial |
$1,196.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.18
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$5,305.11
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$144.87 |
| Max. Negotiated Rate |
$4,509.34 |
| Rate for Payer: AlohaCare Medicaid |
$163.07
|
| Rate for Payer: AlohaCare Medicare |
$144.87
|
| Rate for Payer: Cash Price |
$3,183.07
|
| Rate for Payer: Cash Price |
$3,183.07
|
| Rate for Payer: Devoted Health Medicare |
$159.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$163.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$257.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$163.07
|
| Rate for Payer: Health Management Network Commercial |
$4,509.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.87
|
| Rate for Payer: University Health Alliance Commercial |
$203.37
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$707.93
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$139.45 |
| Max. Negotiated Rate |
$601.74 |
| Rate for Payer: AlohaCare Medicaid |
$155.10
|
| Rate for Payer: AlohaCare Medicare |
$139.45
|
| Rate for Payer: Cash Price |
$424.76
|
| Rate for Payer: Cash Price |
$424.76
|
| Rate for Payer: Devoted Health Medicare |
$153.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$257.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$155.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.46
|
| Rate for Payer: Health Management Network Commercial |
$601.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.45
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.10
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$654.59 |
| Rate for Payer: AlohaCare Medicaid |
$283.86
|
| Rate for Payer: AlohaCare Medicare |
$250.56
|
| Rate for Payer: Cash Price |
$462.06
|
| Rate for Payer: Cash Price |
$462.06
|
| Rate for Payer: Devoted Health Medicare |
$275.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$283.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$473.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$283.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$391.82
|
| Rate for Payer: Health Management Network Commercial |
$654.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$300.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$283.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.56
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$1,465.66
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$1,245.81 |
| Rate for Payer: AlohaCare Medicaid |
$198.28
|
| Rate for Payer: AlohaCare Medicare |
$172.55
|
| Rate for Payer: Cash Price |
$879.40
|
| Rate for Payer: Cash Price |
$879.40
|
| Rate for Payer: Devoted Health Medicare |
$189.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$198.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$333.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$198.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.42
|
| Rate for Payer: Health Management Network Commercial |
$1,245.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.55
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$354.45 |
| Rate for Payer: AlohaCare Medicaid |
$243.42
|
| Rate for Payer: AlohaCare Medicare |
$215.25
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Devoted Health Medicare |
$236.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.72
|
| Rate for Payer: Health Management Network Commercial |
$354.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.25
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$245.07 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: AlohaCare Medicaid |
$276.73
|
| Rate for Payer: AlohaCare Medicare |
$245.07
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Devoted Health Medicare |
$269.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.44
|
| Rate for Payer: Health Management Network Commercial |
$402.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$276.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.07
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$560.47
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$476.40 |
| Rate for Payer: AlohaCare Medicaid |
$150.56
|
| Rate for Payer: AlohaCare Medicare |
$133.80
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Devoted Health Medicare |
$147.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$250.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.46
|
| Rate for Payer: Health Management Network Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.80
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: AlohaCare Medicaid |
$281.06
|
| Rate for Payer: AlohaCare Medicare |
$248.64
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Devoted Health Medicare |
$273.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.80
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$281.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$281.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.64
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$269.82 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: AlohaCare Medicaid |
$305.71
|
| Rate for Payer: AlohaCare Medicare |
$269.82
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Devoted Health Medicare |
$296.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.82
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$305.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$305.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.82
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: AlohaCare Medicaid |
$386.17
|
| Rate for Payer: AlohaCare Medicare |
$340.00
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Devoted Health Medicare |
$374.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$340.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.80
|
| Rate for Payer: Health Management Network Commercial |
$562.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$408.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$408.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$386.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$340.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$340.00
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$308.37 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: AlohaCare Medicaid |
$349.39
|
| Rate for Payer: AlohaCare Medicare |
$308.37
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Devoted Health Medicare |
$339.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$410.54
|
| Rate for Payer: Health Management Network Commercial |
$509.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$370.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$370.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$349.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.37
|
|
|
PR CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS
|
Professional
|
Both
|
$822.73
|
|
|
Service Code
|
HCPCS 52007
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$699.32 |
| Rate for Payer: AlohaCare Medicaid |
$165.56
|
| Rate for Payer: AlohaCare Medicare |
$147.33
|
| Rate for Payer: Cash Price |
$493.64
|
| Rate for Payer: Cash Price |
$493.64
|
| Rate for Payer: Devoted Health Medicare |
$162.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$274.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.76
|
| Rate for Payer: Health Management Network Commercial |
$699.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.33
|
| Rate for Payer: University Health Alliance Commercial |
$215.86
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$264.15 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: AlohaCare Medicaid |
$299.13
|
| Rate for Payer: AlohaCare Medicare |
$264.15
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$290.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$329.94
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$316.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$299.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.15
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$386.66 |
| Max. Negotiated Rate |
$640.05 |
| Rate for Payer: AlohaCare Medicaid |
$439.27
|
| Rate for Payer: AlohaCare Medicare |
$386.66
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Devoted Health Medicare |
$425.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$386.66
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$463.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$463.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$386.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$439.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$386.66
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$321.11 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: AlohaCare Medicaid |
$364.52
|
| Rate for Payer: AlohaCare Medicare |
$321.11
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Devoted Health Medicare |
$353.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.11
|
| Rate for Payer: Health Management Network Commercial |
$530.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.11
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$342.44 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: AlohaCare Medicaid |
$388.78
|
| Rate for Payer: AlohaCare Medicare |
$342.44
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Devoted Health Medicare |
$376.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$416.26
|
| Rate for Payer: Health Management Network Commercial |
$566.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$410.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$388.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$388.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.44
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$111.28
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$94.59 |
| Rate for Payer: AlohaCare Medicaid |
$27.41
|
| Rate for Payer: AlohaCare Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$66.77
|
| Rate for Payer: Cash Price |
$66.77
|
| Rate for Payer: Devoted Health Medicare |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$94.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.09
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$50.54
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: AlohaCare Medicaid |
$14.75
|
| Rate for Payer: AlohaCare Medicare |
$12.55
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Devoted Health Medicare |
$13.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.84
|
| Rate for Payer: Health Management Network Commercial |
$42.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.55
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,269.70
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$356.79 |
| Max. Negotiated Rate |
$1,079.24 |
| Rate for Payer: AlohaCare Medicaid |
$413.97
|
| Rate for Payer: AlohaCare Medicare |
$356.79
|
| Rate for Payer: Cash Price |
$761.82
|
| Rate for Payer: Cash Price |
$761.82
|
| Rate for Payer: Devoted Health Medicare |
$392.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$413.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$694.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$413.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$520.26
|
| Rate for Payer: Health Management Network Commercial |
$1,079.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$413.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.79
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$486.13 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: AlohaCare Medicaid |
$549.81
|
| Rate for Payer: AlohaCare Medicare |
$486.13
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Devoted Health Medicare |
$534.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$486.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$535.60
|
| Rate for Payer: Health Management Network Commercial |
$799.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$583.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$583.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$486.13
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,075.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$791.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.83
|
| Rate for Payer: University Health Alliance Commercial |
$1,026.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$598.41 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: AlohaCare Medicaid |
$673.84
|
| Rate for Payer: AlohaCare Medicare |
$598.41
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Devoted Health Medicare |
$658.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$598.41
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$718.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$673.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$673.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$598.41
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$876.54
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$250.99 |
| Max. Negotiated Rate |
$745.06 |
| Rate for Payer: AlohaCare Medicaid |
$280.66
|
| Rate for Payer: AlohaCare Medicare |
$250.99
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Devoted Health Medicare |
$276.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$280.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$467.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$280.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.36
|
| Rate for Payer: Health Management Network Commercial |
$745.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.99
|
| Rate for Payer: University Health Alliance Commercial |
$321.89
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,000.07
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$850.06 |
| Rate for Payer: AlohaCare Medicaid |
$296.15
|
| Rate for Payer: AlohaCare Medicare |
$261.39
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Devoted Health Medicare |
$287.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$296.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$495.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$296.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.10
|
| Rate for Payer: Health Management Network Commercial |
$850.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.39
|
| Rate for Payer: University Health Alliance Commercial |
$500.00
|
|
