|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
Both
|
$408.06
|
|
|
Service Code
|
HCPCS 10061
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$346.85 |
| Rate for Payer: AlohaCare Medicaid |
$194.24
|
| Rate for Payer: AlohaCare Medicare |
$180.01
|
| Rate for Payer: Cash Price |
$244.84
|
| Rate for Payer: Cash Price |
$244.84
|
| Rate for Payer: Devoted Health Medicare |
$198.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$346.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.01
|
| Rate for Payer: University Health Alliance Commercial |
$209.93
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$242.10
|
|
|
Service Code
|
HCPCS 10060
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$205.78 |
| Rate for Payer: AlohaCare Medicaid |
$114.56
|
| Rate for Payer: AlohaCare Medicare |
$106.44
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Devoted Health Medicare |
$117.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$180.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.56
|
| Rate for Payer: Health Management Network Commercial |
$205.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.44
|
|
|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$311.48
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$269.92 |
| Rate for Payer: AlohaCare Medicaid |
$96.14
|
| Rate for Payer: AlohaCare Medicare |
$86.46
|
| Rate for Payer: Cash Price |
$186.89
|
| Rate for Payer: Cash Price |
$186.89
|
| Rate for Payer: Devoted Health Medicare |
$95.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$269.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$264.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.46
|
| Rate for Payer: University Health Alliance Commercial |
$127.57
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$539.30
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$458.40 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$323.58
|
| Rate for Payer: Cash Price |
$323.58
|
| Rate for Payer: Devoted Health Medicare |
$198.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$458.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$578.85 |
| Rate for Payer: AlohaCare Medicaid |
$395.75
|
| Rate for Payer: AlohaCare Medicare |
$378.37
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Devoted Health Medicare |
$416.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$378.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$578.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$454.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$378.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$378.37
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,013.11
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$275.86 |
| Max. Negotiated Rate |
$861.14 |
| Rate for Payer: AlohaCare Medicaid |
$407.55
|
| Rate for Payer: AlohaCare Medicare |
$381.82
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Devoted Health Medicare |
$420.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$407.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$679.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$381.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.86
|
| Rate for Payer: Health Management Network Commercial |
$861.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$458.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$458.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$458.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$407.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$381.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$407.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$381.82
|
| Rate for Payer: University Health Alliance Commercial |
$505.35
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$721.10
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$612.93 |
| Rate for Payer: AlohaCare Medicaid |
$175.37
|
| Rate for Payer: AlohaCare Medicare |
$171.67
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Devoted Health Medicare |
$188.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$175.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$175.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.54
|
| Rate for Payer: Health Management Network Commercial |
$612.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$175.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.67
|
| Rate for Payer: University Health Alliance Commercial |
$201.59
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$520.28
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$442.24 |
| Rate for Payer: AlohaCare Medicaid |
$111.66
|
| Rate for Payer: AlohaCare Medicare |
$110.45
|
| Rate for Payer: Cash Price |
$312.17
|
| Rate for Payer: Cash Price |
$312.17
|
| Rate for Payer: Devoted Health Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$181.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$442.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.45
|
| Rate for Payer: University Health Alliance Commercial |
$120.86
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$618.90
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$526.07 |
| Rate for Payer: AlohaCare Medicaid |
$172.20
|
| Rate for Payer: AlohaCare Medicare |
$165.68
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Devoted Health Medicare |
$182.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$281.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$526.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.68
|
| Rate for Payer: University Health Alliance Commercial |
$221.37
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$311.22 |
| Max. Negotiated Rate |
$552.50 |
| Rate for Payer: AlohaCare Medicaid |
$377.56
|
| Rate for Payer: AlohaCare Medicare |
$358.85
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$394.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$311.22
|
| Rate for Payer: Health Management Network Commercial |
$552.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$377.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.85
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$197.02
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$167.47 |
| Rate for Payer: AlohaCare Medicaid |
$31.52
|
| Rate for Payer: AlohaCare Medicare |
$30.17
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Devoted Health Medicare |
$33.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.88
|
| Rate for Payer: Health Management Network Commercial |
$167.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.17
|
| Rate for Payer: University Health Alliance Commercial |
$65.00
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$406.16
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$345.24 |
| Rate for Payer: AlohaCare Medicaid |
$118.73
|
| Rate for Payer: AlohaCare Medicare |
$108.66
|
| Rate for Payer: Cash Price |
$243.70
|
| Rate for Payer: Cash Price |
$243.70
|
| Rate for Payer: Devoted Health Medicare |
$119.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$192.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network Commercial |
$345.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.66
|
| Rate for Payer: University Health Alliance Commercial |
$250.00
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$513.85
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$436.77 |
| Rate for Payer: AlohaCare Medicaid |
$189.71
|
| Rate for Payer: AlohaCare Medicare |
$175.90
|
| Rate for Payer: Cash Price |
$308.31
|
| Rate for Payer: Cash Price |
$308.31
|
| Rate for Payer: Devoted Health Medicare |
$193.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$314.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.06
|
| Rate for Payer: Health Management Network Commercial |
$436.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.90
|
| Rate for Payer: University Health Alliance Commercial |
$216.52
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$298.94
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: AlohaCare Medicaid |
$113.02
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Devoted Health Medicare |
$118.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$172.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$254.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.15
|
| Rate for Payer: University Health Alliance Commercial |
$125.09
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$428.84
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$364.51 |
| Rate for Payer: AlohaCare Medicaid |
$114.89
|
| Rate for Payer: AlohaCare Medicare |
$110.61
|
| Rate for Payer: Cash Price |
$257.30
|
| Rate for Payer: Cash Price |
$257.30
|
| Rate for Payer: Devoted Health Medicare |
$121.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$187.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$364.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.61
|
| Rate for Payer: University Health Alliance Commercial |
$175.00
|
|
|
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 90875
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.23
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
|
|
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 90876
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.79
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: AlohaCare Medicaid |
$423.51
|
| Rate for Payer: AlohaCare Medicare |
$372.48
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Devoted Health Medicare |
$409.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.98
|
| Rate for Payer: Health Management Network Commercial |
$610.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$446.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$446.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$423.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$423.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.48
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$741.51
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$630.28 |
| Rate for Payer: AlohaCare Medicaid |
$370.89
|
| Rate for Payer: AlohaCare Medicare |
$324.41
|
| Rate for Payer: Cash Price |
$444.91
|
| Rate for Payer: Cash Price |
$444.91
|
| Rate for Payer: Devoted Health Medicare |
$356.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$370.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$387.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$370.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.52
|
| Rate for Payer: Health Management Network Commercial |
$630.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$389.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$389.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.41
|
| Rate for Payer: University Health Alliance Commercial |
$491.55
|
|
|
PR INDWELLING CATHETER LATEX
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A4338
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: AlohaCare Medicaid |
$8.32
|
| Rate for Payer: AlohaCare Medicare |
$18.88
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$20.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.88
|
|
|
PR INFLUENZA VIRUS VACCINE, NOS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS Q2039
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$47.57 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$295.67 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: AlohaCare Medicaid |
$339.70
|
| Rate for Payer: AlohaCare Medicare |
$295.67
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Devoted Health Medicare |
$325.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.05
|
| Rate for Payer: Health Management Network Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$354.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.67
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$348.60
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: AlohaCare Medicaid |
$185.44
|
| Rate for Payer: AlohaCare Medicare |
$165.40
|
| Rate for Payer: Cash Price |
$209.16
|
| Rate for Payer: Cash Price |
$209.16
|
| Rate for Payer: Devoted Health Medicare |
$181.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.07
|
| Rate for Payer: Health Management Network Commercial |
$296.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$185.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.40
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$254.57
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$76.02 |
| Max. Negotiated Rate |
$216.38 |
| Rate for Payer: AlohaCare Medicaid |
$136.11
|
| Rate for Payer: AlohaCare Medicare |
$121.54
|
| Rate for Payer: Cash Price |
$152.74
|
| Rate for Payer: Cash Price |
$152.74
|
| Rate for Payer: Devoted Health Medicare |
$133.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.02
|
| Rate for Payer: Health Management Network Commercial |
$216.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.54
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$146.54
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$124.56 |
| Rate for Payer: AlohaCare Medicaid |
$81.82
|
| Rate for Payer: AlohaCare Medicare |
$72.35
|
| Rate for Payer: Cash Price |
$87.92
|
| Rate for Payer: Cash Price |
$87.92
|
| Rate for Payer: Devoted Health Medicare |
$79.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.35
|
| Rate for Payer: Health Management Network Commercial |
$124.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.35
|
|
