|
PR I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 54700
|
| Min. Negotiated Rate |
$203.07 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$218.76
|
| Rate for Payer: AlohaCare Medicare |
$203.07
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Devoted Health Medicare |
$223.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.16
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.07
|
|
|
PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,292.71
|
|
|
Service Code
|
HCPCS 25028
|
| Min. Negotiated Rate |
$254.02 |
| Max. Negotiated Rate |
$1,098.80 |
| Rate for Payer: AlohaCare Medicaid |
$755.13
|
| Rate for Payer: AlohaCare Medicare |
$738.31
|
| Rate for Payer: Cash Price |
$775.63
|
| Rate for Payer: Cash Price |
$775.63
|
| Rate for Payer: Devoted Health Medicare |
$812.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$738.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.02
|
| Rate for Payer: Health Management Network Commercial |
$1,098.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$885.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$885.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$885.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$755.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$738.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$755.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$738.31
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$327.74
|
|
|
Service Code
|
HCPCS 10140
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$278.58 |
| Rate for Payer: AlohaCare Medicaid |
$124.60
|
| Rate for Payer: AlohaCare Medicare |
$120.44
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Devoted Health Medicare |
$132.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$204.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$278.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.44
|
| Rate for Payer: University Health Alliance Commercial |
$140.50
|
|
|
PR I&D INTRAMURAL IM/ABSC TRANSANAL ANES
|
Professional
|
Both
|
$804.65
|
|
|
Service Code
|
HCPCS 46045
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$683.95 |
| Rate for Payer: AlohaCare Medicaid |
$456.47
|
| Rate for Payer: AlohaCare Medicare |
$459.42
|
| Rate for Payer: Cash Price |
$482.79
|
| Rate for Payer: Cash Price |
$482.79
|
| Rate for Payer: Devoted Health Medicare |
$505.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$459.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$183.56
|
| Rate for Payer: Health Management Network Commercial |
$683.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$551.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$551.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$551.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$456.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$459.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$459.42
|
|
|
PR I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON
|
Professional
|
Both
|
$889.42
|
|
|
Service Code
|
HCPCS 46060
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$756.01 |
| Rate for Payer: AlohaCare Medicaid |
$508.11
|
| Rate for Payer: AlohaCare Medicare |
$508.24
|
| Rate for Payer: Cash Price |
$533.65
|
| Rate for Payer: Cash Price |
$533.65
|
| Rate for Payer: Devoted Health Medicare |
$559.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$508.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.70
|
| Rate for Payer: Health Management Network Commercial |
$756.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$609.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$609.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$508.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$508.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$508.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$508.24
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$1,172.99
|
|
|
Service Code
|
HCPCS 46040
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$997.04 |
| Rate for Payer: AlohaCare Medicaid |
$443.86
|
| Rate for Payer: AlohaCare Medicare |
$448.12
|
| Rate for Payer: Cash Price |
$703.79
|
| Rate for Payer: Cash Price |
$703.79
|
| Rate for Payer: Devoted Health Medicare |
$492.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$443.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$734.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$443.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$997.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$537.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$537.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$537.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$443.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.12
|
| Rate for Payer: University Health Alliance Commercial |
$555.80
|
|
|
PR I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$343.16
|
|
|
Service Code
|
HCPCS 56420
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$291.69 |
| Rate for Payer: AlohaCare Medicaid |
$116.29
|
| Rate for Payer: AlohaCare Medicare |
$103.05
|
| Rate for Payer: Cash Price |
$205.90
|
| Rate for Payer: Cash Price |
$205.90
|
| Rate for Payer: Devoted Health Medicare |
$113.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.50
|
| Rate for Payer: Health Management Network Commercial |
$291.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.05
|
| Rate for Payer: University Health Alliance Commercial |
$153.72
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$718.45
|
| Rate for Payer: AlohaCare Medicare |
$684.41
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$752.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$684.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$232.44
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$821.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$821.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$821.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$684.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$718.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$684.41
|
|
|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: AlohaCare Medicaid |
$309.31
|
| Rate for Payer: AlohaCare Medicare |
$278.97
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$306.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$334.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$334.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.97
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$514.15
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$437.03 |
| Rate for Payer: AlohaCare Medicaid |
$106.57
|
| Rate for Payer: AlohaCare Medicare |
$107.72
|
| Rate for Payer: Cash Price |
$308.49
|
| Rate for Payer: Cash Price |
$308.49
|
| Rate for Payer: Devoted Health Medicare |
$118.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$174.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.88
|
| Rate for Payer: Health Management Network Commercial |
$437.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.72
|
| Rate for Payer: University Health Alliance Commercial |
$150.00
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$893.16
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$759.19 |
| Rate for Payer: AlohaCare Medicaid |
$264.74
|
| Rate for Payer: AlohaCare Medicare |
$248.72
|
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Devoted Health Medicare |
$273.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$264.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$439.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$264.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$759.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.72
|
| Rate for Payer: University Health Alliance Commercial |
$346.19
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: AlohaCare Medicaid |
$233.94
|
| Rate for Payer: AlohaCare Medicare |
$222.26
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$244.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$233.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$379.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$233.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.26
|
| Rate for Payer: University Health Alliance Commercial |
$299.00
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$697.99
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$113.88 |
| Max. Negotiated Rate |
$593.29 |
| Rate for Payer: AlohaCare Medicaid |
$171.24
|
| Rate for Payer: AlohaCare Medicare |
$178.96
|
| Rate for Payer: Cash Price |
$418.79
|
| Rate for Payer: Cash Price |
$418.79
|
| Rate for Payer: Devoted Health Medicare |
$196.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$285.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.88
|
| Rate for Payer: Health Management Network Commercial |
$593.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.96
|
| Rate for Payer: University Health Alliance Commercial |
$230.38
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$715.02
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$607.77 |
| Rate for Payer: AlohaCare Medicaid |
$222.59
|
| Rate for Payer: AlohaCare Medicare |
$208.45
|
| Rate for Payer: Cash Price |
$429.01
|
| Rate for Payer: Cash Price |
$429.01
|
| Rate for Payer: Devoted Health Medicare |
$229.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$222.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$369.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$222.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.12
|
| Rate for Payer: Health Management Network Commercial |
$607.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$250.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$250.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$222.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$222.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.45
|
| Rate for Payer: University Health Alliance Commercial |
$291.27
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$270.34
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$229.79 |
| Rate for Payer: AlohaCare Medicaid |
$134.97
|
| Rate for Payer: AlohaCare Medicare |
$121.44
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Cash Price |
$162.20
|
| Rate for Payer: Devoted Health Medicare |
$133.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$229.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.44
|
| Rate for Payer: University Health Alliance Commercial |
$177.04
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$23.22
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Devoted Health Medicare |
$25.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.73
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.22
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.08
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.01
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.30
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.08
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$98.16
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Devoted Health Medicare |
$107.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.06
|
| Rate for Payer: Health Management Network Commercial |
$307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.16
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$435.54
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$370.21 |
| Rate for Payer: AlohaCare Medicaid |
$58.93
|
| Rate for Payer: AlohaCare Medicare |
$54.82
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Devoted Health Medicare |
$60.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$104.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$370.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.82
|
| Rate for Payer: University Health Alliance Commercial |
$75.74
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$592.80 |
| Max. Negotiated Rate |
$1,496.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,027.68
|
| Rate for Payer: AlohaCare Medicare |
$949.96
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Devoted Health Medicare |
$1,044.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$592.80
|
| Rate for Payer: Health Management Network Commercial |
$1,496.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,027.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,027.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.96
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$32.86
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$27.93 |
| Rate for Payer: AlohaCare Medicare |
$18.78
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Devoted Health Medicare |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.00
|
| Rate for Payer: Health Management Network Commercial |
$27.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.78
|
|
