|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$447.11
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$141.56 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: AlohaCare Medicaid |
$172.86
|
| Rate for Payer: AlohaCare Medicare |
$141.56
|
| Rate for Payer: Cash Price |
$268.27
|
| Rate for Payer: Cash Price |
$268.27
|
| Rate for Payer: Devoted Health Medicare |
$155.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$264.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.66
|
| Rate for Payer: Health Management Network Commercial |
$380.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.56
|
| Rate for Payer: University Health Alliance Commercial |
$195.40
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: AlohaCare Medicaid |
$74.37
|
| Rate for Payer: AlohaCare Medicare |
$61.43
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$67.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$74.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$113.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.43
|
| Rate for Payer: University Health Alliance Commercial |
$83.93
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$102.09 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: AlohaCare Medicaid |
$122.90
|
| Rate for Payer: AlohaCare Medicare |
$102.09
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Devoted Health Medicare |
$112.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$186.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$145.08
|
| Rate for Payer: Health Management Network Commercial |
$281.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.09
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$116.44 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: AlohaCare Medicaid |
$141.38
|
| Rate for Payer: AlohaCare Medicare |
$116.44
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Devoted Health Medicare |
$128.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.20
|
| Rate for Payer: Health Management Network Commercial |
$320.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.44
|
| Rate for Payer: University Health Alliance Commercial |
$159.42
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: AlohaCare Medicaid |
$176.04
|
| Rate for Payer: AlohaCare Medicare |
$143.61
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$157.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$267.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.61
|
| Rate for Payer: University Health Alliance Commercial |
$198.22
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$505.22
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$167.56 |
| Max. Negotiated Rate |
$429.44 |
| Rate for Payer: AlohaCare Medicaid |
$204.28
|
| Rate for Payer: AlohaCare Medicare |
$167.56
|
| Rate for Payer: Cash Price |
$303.13
|
| Rate for Payer: Cash Price |
$303.13
|
| Rate for Payer: Devoted Health Medicare |
$184.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$204.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$313.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$204.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$429.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.56
|
| Rate for Payer: University Health Alliance Commercial |
$231.68
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: AlohaCare Medicaid |
$91.61
|
| Rate for Payer: AlohaCare Medicare |
$77.01
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Devoted Health Medicare |
$84.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.32
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.01
|
| Rate for Payer: University Health Alliance Commercial |
$102.00
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: AlohaCare Medicaid |
$115.19
|
| Rate for Payer: AlohaCare Medicare |
$95.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Devoted Health Medicare |
$105.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$115.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$174.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$115.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.52
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.70
|
| Rate for Payer: University Health Alliance Commercial |
$129.12
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: AlohaCare Medicaid |
$127.14
|
| Rate for Payer: AlohaCare Medicare |
$105.04
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$115.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$193.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$127.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.04
|
| Rate for Payer: University Health Alliance Commercial |
$143.05
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$380.34
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$323.29 |
| Rate for Payer: AlohaCare Medicaid |
$135.57
|
| Rate for Payer: AlohaCare Medicare |
$111.77
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Devoted Health Medicare |
$122.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.78
|
| Rate for Payer: Health Management Network Commercial |
$323.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.77
|
| Rate for Payer: University Health Alliance Commercial |
$152.64
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$792.07
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$136.26 |
| Max. Negotiated Rate |
$673.26 |
| Rate for Payer: AlohaCare Medicaid |
$149.86
|
| Rate for Payer: AlohaCare Medicare |
$136.26
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Devoted Health Medicare |
$149.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$149.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.98
|
| Rate for Payer: Health Management Network Commercial |
$673.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.26
|
| Rate for Payer: University Health Alliance Commercial |
$195.96
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$308.02
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$85.63
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Devoted Health Medicare |
$94.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$188.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$261.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.63
|
| Rate for Payer: University Health Alliance Commercial |
$115.54
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: AlohaCare Medicaid |
$59.29
|
| Rate for Payer: AlohaCare Medicare |
$50.49
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$55.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.12
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.49
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: AlohaCare Medicaid |
$2.10
|
| Rate for Payer: AlohaCare Medicare |
$1.72
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.72
|
| Rate for Payer: University Health Alliance Commercial |
$2.43
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$84.01 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.01
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
|
|
PR DIAB MANAGE TRN IND/GROUP
|
Professional
|
Both
|
$29.58
|
|
|
Service Code
|
HCPCS G0109
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: AlohaCare Medicaid |
$16.54
|
| Rate for Payer: AlohaCare Medicare |
$16.90
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Devoted Health Medicare |
$18.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network Commercial |
$25.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.90
|
|
|
PR DIAB MANAGE TRN PER INDIV
|
Professional
|
Both
|
$102.48
|
|
|
Service Code
|
HCPCS G0108
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$87.11 |
| Rate for Payer: AlohaCare Medicaid |
$57.10
|
| Rate for Payer: AlohaCare Medicare |
$58.56
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Devoted Health Medicare |
$64.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.73
|
| Rate for Payer: Health Management Network Commercial |
$87.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.56
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$342.68 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: AlohaCare Medicaid |
$492.40
|
| Rate for Payer: AlohaCare Medicare |
$460.95
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Devoted Health Medicare |
$507.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$460.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.68
|
| Rate for Payer: Health Management Network Commercial |
$724.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$553.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$553.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$460.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$492.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$460.95
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$321.98
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$273.68 |
| Rate for Payer: AlohaCare Medicaid |
$68.20
|
| Rate for Payer: AlohaCare Medicare |
$56.01
|
| Rate for Payer: Cash Price |
$193.19
|
| Rate for Payer: Cash Price |
$193.19
|
| Rate for Payer: Devoted Health Medicare |
$61.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$212.16
|
| Rate for Payer: Health Management Network Commercial |
$273.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.01
|
| Rate for Payer: University Health Alliance Commercial |
$93.68
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$319.36
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$271.46 |
| Rate for Payer: AlohaCare Medicaid |
$71.25
|
| Rate for Payer: AlohaCare Medicare |
$57.93
|
| Rate for Payer: Cash Price |
$191.62
|
| Rate for Payer: Cash Price |
$191.62
|
| Rate for Payer: Devoted Health Medicare |
$63.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.94
|
| Rate for Payer: Health Management Network Commercial |
$271.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.93
|
| Rate for Payer: University Health Alliance Commercial |
$94.65
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$336.79
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$62.19 |
| Max. Negotiated Rate |
$286.27 |
| Rate for Payer: AlohaCare Medicaid |
$75.42
|
| Rate for Payer: AlohaCare Medicare |
$62.19
|
| Rate for Payer: Cash Price |
$202.07
|
| Rate for Payer: Cash Price |
$202.07
|
| Rate for Payer: Devoted Health Medicare |
$68.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.32
|
| Rate for Payer: Health Management Network Commercial |
$286.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.19
|
| Rate for Payer: University Health Alliance Commercial |
$110.00
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$309.33
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$262.93 |
| Rate for Payer: AlohaCare Medicaid |
$61.33
|
| Rate for Payer: AlohaCare Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Devoted Health Medicare |
$61.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.68
|
| Rate for Payer: Health Management Network Commercial |
$262.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.99
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$409.92
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$72.46 |
| Max. Negotiated Rate |
$348.43 |
| Rate for Payer: AlohaCare Medicaid |
$84.48
|
| Rate for Payer: AlohaCare Medicare |
$72.46
|
| Rate for Payer: Cash Price |
$245.95
|
| Rate for Payer: Cash Price |
$245.95
|
| Rate for Payer: Devoted Health Medicare |
$79.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.50
|
| Rate for Payer: Health Management Network Commercial |
$348.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.46
|
| Rate for Payer: University Health Alliance Commercial |
$119.37
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$3,563.35
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$3,028.85 |
| Rate for Payer: AlohaCare Medicaid |
$190.20
|
| Rate for Payer: AlohaCare Medicare |
$168.88
|
| Rate for Payer: Cash Price |
$2,138.01
|
| Rate for Payer: Cash Price |
$2,138.01
|
| Rate for Payer: Devoted Health Medicare |
$185.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$190.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$190.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,260.96
|
| Rate for Payer: Health Management Network Commercial |
$3,028.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.88
|
| Rate for Payer: University Health Alliance Commercial |
$270.00
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: AlohaCare Medicaid |
$324.41
|
| Rate for Payer: AlohaCare Medicare |
$341.54
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Devoted Health Medicare |
$375.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$341.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.59
|
| Rate for Payer: Health Management Network Commercial |
$756.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$409.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$409.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$409.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$341.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$341.54
|
|
