|
PR DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL
|
Professional
|
Both
|
$344.45
|
|
|
Service Code
|
HCPCS 42310
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: AlohaCare Medicaid |
$144.35
|
| Rate for Payer: AlohaCare Medicare |
$134.17
|
| Rate for Payer: Cash Price |
$206.67
|
| Rate for Payer: Cash Price |
$206.67
|
| Rate for Payer: Devoted Health Medicare |
$147.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.64
|
| Rate for Payer: Health Management Network Commercial |
$292.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.17
|
| Rate for Payer: University Health Alliance Commercial |
$186.52
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: AlohaCare Medicaid |
$506.91
|
| Rate for Payer: AlohaCare Medicare |
$496.42
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Devoted Health Medicare |
$546.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$496.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.72
|
| Rate for Payer: Health Management Network Commercial |
$739.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$595.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$595.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$496.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$496.42
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$715.33
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$608.03 |
| Rate for Payer: AlohaCare Medicaid |
$219.80
|
| Rate for Payer: AlohaCare Medicare |
$223.82
|
| Rate for Payer: Cash Price |
$429.20
|
| Rate for Payer: Cash Price |
$429.20
|
| Rate for Payer: Devoted Health Medicare |
$246.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$219.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$296.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$219.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.34
|
| Rate for Payer: Health Management Network Commercial |
$608.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$219.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.82
|
| Rate for Payer: University Health Alliance Commercial |
$288.33
|
|
|
PR DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN
|
Professional
|
Both
|
$1,310.00
|
|
|
Service Code
|
HCPCS 49062
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: AlohaCare Medicaid |
$764.31
|
| Rate for Payer: AlohaCare Medicare |
$720.20
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Devoted Health Medicare |
$792.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$720.20
|
| Rate for Payer: Health Management Network Commercial |
$1,113.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$864.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$864.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$764.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$764.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.20
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$395.06
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$335.80 |
| Rate for Payer: AlohaCare Medicaid |
$132.54
|
| Rate for Payer: AlohaCare Medicare |
$122.45
|
| Rate for Payer: Cash Price |
$237.04
|
| Rate for Payer: Cash Price |
$237.04
|
| Rate for Payer: Devoted Health Medicare |
$134.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$205.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$335.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.45
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$307.21
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: AlohaCare Medicaid |
$113.44
|
| Rate for Payer: AlohaCare Medicare |
$103.02
|
| Rate for Payer: Cash Price |
$184.33
|
| Rate for Payer: Cash Price |
$184.33
|
| Rate for Payer: Devoted Health Medicare |
$113.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$261.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.02
|
| Rate for Payer: University Health Alliance Commercial |
$129.83
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$175.32
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$149.02 |
| Rate for Payer: AlohaCare Medicaid |
$58.39
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$105.19
|
| Rate for Payer: Cash Price |
$105.19
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$149.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
| Rate for Payer: University Health Alliance Commercial |
$100.00
|
|
|
PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$974.35 |
| Max. Negotiated Rate |
$1,546.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,064.19
|
| Rate for Payer: AlohaCare Medicare |
$974.35
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Devoted Health Medicare |
$1,071.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$974.35
|
| Rate for Payer: Health Management Network Commercial |
$1,546.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,169.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,169.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,169.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,064.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$974.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,064.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$974.35
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$1,200.85
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$172.38 |
| Max. Negotiated Rate |
$1,020.72 |
| Rate for Payer: AlohaCare Medicaid |
$186.48
|
| Rate for Payer: AlohaCare Medicare |
$175.03
|
| Rate for Payer: Cash Price |
$720.51
|
| Rate for Payer: Cash Price |
$720.51
|
| Rate for Payer: Devoted Health Medicare |
$192.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$186.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$172.38
|
| Rate for Payer: Health Management Network Commercial |
$1,020.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.03
|
| Rate for Payer: University Health Alliance Commercial |
$245.26
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$510.96
|
|
|
Service Code
|
HCPCS 46900
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$434.32 |
| Rate for Payer: AlohaCare Medicaid |
$144.16
|
| Rate for Payer: AlohaCare Medicare |
$137.03
|
| Rate for Payer: Cash Price |
$306.58
|
| Rate for Payer: Cash Price |
$306.58
|
| Rate for Payer: Devoted Health Medicare |
$150.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$219.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$434.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.03
|
| Rate for Payer: University Health Alliance Commercial |
$186.14
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$484.33
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$84.76 |
| Max. Negotiated Rate |
$411.68 |
| Rate for Payer: AlohaCare Medicaid |
$149.92
|
| Rate for Payer: AlohaCare Medicare |
$126.76
|
| Rate for Payer: Cash Price |
$290.60
|
| Rate for Payer: Cash Price |
$290.60
|
| Rate for Payer: Devoted Health Medicare |
$139.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$149.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.76
|
| Rate for Payer: Health Management Network Commercial |
$411.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.76
|
| Rate for Payer: University Health Alliance Commercial |
$196.67
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$900.10
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$123.56 |
| Max. Negotiated Rate |
$765.09 |
| Rate for Payer: AlohaCare Medicaid |
$133.82
|
| Rate for Payer: AlohaCare Medicare |
$123.56
|
| Rate for Payer: Cash Price |
$540.06
|
| Rate for Payer: Cash Price |
$540.06
|
| Rate for Payer: Devoted Health Medicare |
$135.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$202.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.40
|
| Rate for Payer: Health Management Network Commercial |
$765.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.56
|
| Rate for Payer: University Health Alliance Commercial |
$171.75
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$658.56
|
|
|
Service Code
|
HCPCS 46922
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$559.78 |
| Rate for Payer: AlohaCare Medicaid |
$142.97
|
| Rate for Payer: AlohaCare Medicare |
$137.45
|
| Rate for Payer: Cash Price |
$395.14
|
| Rate for Payer: Cash Price |
$395.14
|
| Rate for Payer: Devoted Health Medicare |
$151.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$220.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.08
|
| Rate for Payer: Health Management Network Commercial |
$559.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.45
|
| Rate for Payer: University Health Alliance Commercial |
$185.97
|
|
|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$566.14
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$481.22 |
| Rate for Payer: AlohaCare Medicaid |
$140.69
|
| Rate for Payer: AlohaCare Medicare |
$133.63
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Devoted Health Medicare |
$146.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$140.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$216.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$140.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.54
|
| Rate for Payer: Health Management Network Commercial |
$481.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.63
|
| Rate for Payer: University Health Alliance Commercial |
$183.40
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$415.84
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$155.59 |
| Max. Negotiated Rate |
$353.46 |
| Rate for Payer: AlohaCare Medicaid |
$180.40
|
| Rate for Payer: AlohaCare Medicare |
$155.59
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Devoted Health Medicare |
$171.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$272.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.58
|
| Rate for Payer: Health Management Network Commercial |
$353.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.59
|
| Rate for Payer: University Health Alliance Commercial |
$231.09
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$275.76
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: AlohaCare Medicaid |
$114.20
|
| Rate for Payer: AlohaCare Medicare |
$101.76
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Devoted Health Medicare |
$111.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.92
|
| Rate for Payer: Health Management Network Commercial |
$234.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.76
|
| Rate for Payer: University Health Alliance Commercial |
$144.21
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$272.11
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$231.29 |
| Rate for Payer: AlohaCare Medicaid |
$120.14
|
| Rate for Payer: AlohaCare Medicare |
$104.60
|
| Rate for Payer: Cash Price |
$163.27
|
| Rate for Payer: Cash Price |
$163.27
|
| Rate for Payer: Devoted Health Medicare |
$115.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$231.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.60
|
| Rate for Payer: University Health Alliance Commercial |
$150.85
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$262.80
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$223.38 |
| Rate for Payer: AlohaCare Medicaid |
$101.78
|
| Rate for Payer: AlohaCare Medicare |
$90.55
|
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Devoted Health Medicare |
$99.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$223.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.55
|
| Rate for Payer: University Health Alliance Commercial |
$127.97
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$271.13
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$230.46 |
| Rate for Payer: AlohaCare Medicaid |
$103.68
|
| Rate for Payer: AlohaCare Medicare |
$94.93
|
| Rate for Payer: Cash Price |
$162.68
|
| Rate for Payer: Cash Price |
$162.68
|
| Rate for Payer: Devoted Health Medicare |
$104.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$155.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.74
|
| Rate for Payer: Health Management Network Commercial |
$230.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.93
|
| Rate for Payer: University Health Alliance Commercial |
$131.75
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$376.81
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$320.29 |
| Rate for Payer: AlohaCare Medicaid |
$137.32
|
| Rate for Payer: AlohaCare Medicare |
$126.07
|
| Rate for Payer: Cash Price |
$226.09
|
| Rate for Payer: Cash Price |
$226.09
|
| Rate for Payer: Devoted Health Medicare |
$138.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$208.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$320.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.07
|
| Rate for Payer: University Health Alliance Commercial |
$176.39
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$486.38
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$413.42 |
| Rate for Payer: AlohaCare Medicaid |
$182.23
|
| Rate for Payer: AlohaCare Medicare |
$165.52
|
| Rate for Payer: Cash Price |
$291.83
|
| Rate for Payer: Cash Price |
$291.83
|
| Rate for Payer: Devoted Health Medicare |
$182.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$182.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network Commercial |
$413.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.52
|
| Rate for Payer: University Health Alliance Commercial |
$240.87
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.43
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$556.75 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Health Management Network Commercial |
$556.75
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.50
|
| Rate for Payer: Health Management Network Commercial |
$213.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.12
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
