|
PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 21554
|
| Min. Negotiated Rate |
$679.77 |
| Max. Negotiated Rate |
$1,082.05 |
| Rate for Payer: AlohaCare Medicaid |
$743.28
|
| Rate for Payer: AlohaCare Medicare |
$679.77
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Devoted Health Medicare |
$747.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$679.77
|
| Rate for Payer: Health Management Network Commercial |
$1,082.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$815.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$815.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$815.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$743.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$679.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$743.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$679.77
|
|
|
PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>
|
Professional
|
Both
|
$1,281.00
|
|
|
Service Code
|
HCPCS 27045
|
| Min. Negotiated Rate |
$691.56 |
| Max. Negotiated Rate |
$1,088.85 |
| Rate for Payer: AlohaCare Medicaid |
$745.77
|
| Rate for Payer: AlohaCare Medicare |
$691.56
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Devoted Health Medicare |
$760.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$691.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$696.54
|
| Rate for Payer: Health Management Network Commercial |
$1,088.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$829.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$829.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$829.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$745.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$691.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$745.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$691.56
|
|
|
PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM
|
Professional
|
Both
|
$988.56
|
|
|
Service Code
|
HCPCS 27047
|
| Min. Negotiated Rate |
$297.18 |
| Max. Negotiated Rate |
$840.28 |
| Rate for Payer: AlohaCare Medicaid |
$374.68
|
| Rate for Payer: AlohaCare Medicare |
$356.78
|
| Rate for Payer: Cash Price |
$593.14
|
| Rate for Payer: Cash Price |
$593.14
|
| Rate for Payer: Devoted Health Medicare |
$392.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$374.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$666.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$374.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$297.18
|
| Rate for Payer: Health Management Network Commercial |
$840.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$428.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$374.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.78
|
| Rate for Payer: University Health Alliance Commercial |
$489.14
|
|
|
PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 23073
|
| Min. Negotiated Rate |
$661.39 |
| Max. Negotiated Rate |
$1,039.55 |
| Rate for Payer: AlohaCare Medicaid |
$712.34
|
| Rate for Payer: AlohaCare Medicare |
$661.39
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Devoted Health Medicare |
$727.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$661.39
|
| Rate for Payer: Health Management Network Commercial |
$1,039.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$793.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$712.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$661.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$712.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$661.39
|
|
|
PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 27328
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$934.15 |
| Rate for Payer: AlohaCare Medicaid |
$641.76
|
| Rate for Payer: AlohaCare Medicare |
$595.03
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Devoted Health Medicare |
$654.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$595.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.76
|
| Rate for Payer: Health Management Network Commercial |
$934.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$714.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$714.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$714.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$595.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$641.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$595.03
|
|
|
PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 24071
|
| Min. Negotiated Rate |
$395.61 |
| Max. Negotiated Rate |
$609.45 |
| Rate for Payer: AlohaCare Medicaid |
$417.69
|
| Rate for Payer: AlohaCare Medicare |
$395.61
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Devoted Health Medicare |
$435.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.61
|
| Rate for Payer: Health Management Network Commercial |
$609.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$474.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$474.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$474.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$417.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$417.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.61
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,070.70
|
|
|
Service Code
|
HCPCS 24075
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$910.10 |
| Rate for Payer: AlohaCare Medicaid |
$345.74
|
| Rate for Payer: AlohaCare Medicare |
$328.91
|
| Rate for Payer: Cash Price |
$642.42
|
| Rate for Payer: Cash Price |
$642.42
|
| Rate for Payer: Devoted Health Medicare |
$361.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$345.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$532.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$345.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$216.58
|
| Rate for Payer: Health Management Network Commercial |
$910.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$345.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.91
|
| Rate for Payer: University Health Alliance Commercial |
$449.80
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 24073
|
| Min. Negotiated Rate |
$655.68 |
| Max. Negotiated Rate |
$1,035.30 |
| Rate for Payer: AlohaCare Medicaid |
$708.34
|
| Rate for Payer: AlohaCare Medicare |
$655.68
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Devoted Health Medicare |
$721.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$655.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$686.92
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$786.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$786.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$708.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$655.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$708.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$655.68
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$979.00
|
|
|
Service Code
|
HCPCS 24076
|
| Min. Negotiated Rate |
$405.86 |
| Max. Negotiated Rate |
$832.15 |
| Rate for Payer: AlohaCare Medicaid |
$569.35
|
| Rate for Payer: AlohaCare Medicare |
$530.33
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Devoted Health Medicare |
$583.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$530.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$405.86
|
| Rate for Payer: Health Management Network Commercial |
$832.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$636.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$636.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$569.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$530.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$569.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$530.33
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,115.64
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$263.64 |
| Max. Negotiated Rate |
$948.29 |
| Rate for Payer: AlohaCare Medicaid |
$355.80
|
| Rate for Payer: AlohaCare Medicare |
$333.70
|
| Rate for Payer: Cash Price |
$669.38
|
| Rate for Payer: Cash Price |
$669.38
|
| Rate for Payer: Devoted Health Medicare |
$367.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$355.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$539.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$333.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$355.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$263.64
|
| Rate for Payer: Health Management Network Commercial |
$948.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$400.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$400.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$355.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$333.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$355.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$333.70
|
| Rate for Payer: University Health Alliance Commercial |
$500.00
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: AlohaCare Medicaid |
$555.78
|
| Rate for Payer: AlohaCare Medicare |
$508.32
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Devoted Health Medicare |
$559.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$508.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.70
|
| Rate for Payer: Health Management Network Commercial |
$814.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$609.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$609.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$555.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$508.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$555.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$508.32
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$501.54 |
| Max. Negotiated Rate |
$901.85 |
| Rate for Payer: AlohaCare Medicaid |
$620.16
|
| Rate for Payer: AlohaCare Medicare |
$556.06
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Devoted Health Medicare |
$611.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$556.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$501.54
|
| Rate for Payer: Health Management Network Commercial |
$901.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$667.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$667.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$620.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$556.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$620.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$556.06
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$332.14 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: AlohaCare Medicaid |
$363.00
|
| Rate for Payer: AlohaCare Medicare |
$332.14
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$365.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$410.80
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$398.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$398.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$363.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.14
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$493.68 |
| Max. Negotiated Rate |
$799.85 |
| Rate for Payer: AlohaCare Medicaid |
$547.56
|
| Rate for Payer: AlohaCare Medicare |
$493.68
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Devoted Health Medicare |
$543.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$493.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$499.20
|
| Rate for Payer: Health Management Network Commercial |
$799.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$592.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$592.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$592.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$547.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$493.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$547.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$493.68
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$881.21
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$749.03 |
| Rate for Payer: AlohaCare Medicaid |
$385.23
|
| Rate for Payer: AlohaCare Medicare |
$341.01
|
| Rate for Payer: Cash Price |
$528.73
|
| Rate for Payer: Cash Price |
$528.73
|
| Rate for Payer: Devoted Health Medicare |
$375.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$385.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$592.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$341.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$385.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.02
|
| Rate for Payer: Health Management Network Commercial |
$749.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$409.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$409.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$409.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$341.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$385.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$341.01
|
| Rate for Payer: University Health Alliance Commercial |
$502.06
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$365.54 |
| Max. Negotiated Rate |
$578.85 |
| Rate for Payer: AlohaCare Medicaid |
$395.91
|
| Rate for Payer: AlohaCare Medicare |
$365.54
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Devoted Health Medicare |
$402.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$365.54
|
| Rate for Payer: Health Management Network Commercial |
$578.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$438.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$438.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$365.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$365.54
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$360.55 |
| Max. Negotiated Rate |
$575.45 |
| Rate for Payer: AlohaCare Medicaid |
$394.79
|
| Rate for Payer: AlohaCare Medicare |
$360.55
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Devoted Health Medicare |
$396.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$360.55
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$432.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$394.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$360.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$394.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$360.55
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,194.16
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$1,015.04 |
| Rate for Payer: AlohaCare Medicaid |
$208.69
|
| Rate for Payer: AlohaCare Medicare |
$199.31
|
| Rate for Payer: Cash Price |
$716.50
|
| Rate for Payer: Cash Price |
$716.50
|
| Rate for Payer: Devoted Health Medicare |
$219.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$208.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$330.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$208.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$145.08
|
| Rate for Payer: Health Management Network Commercial |
$1,015.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.31
|
| Rate for Payer: University Health Alliance Commercial |
$281.32
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,103.01
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$937.56 |
| Rate for Payer: AlohaCare Medicaid |
$350.36
|
| Rate for Payer: AlohaCare Medicare |
$316.98
|
| Rate for Payer: Cash Price |
$661.81
|
| Rate for Payer: Cash Price |
$661.81
|
| Rate for Payer: Devoted Health Medicare |
$348.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$350.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$544.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$350.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$315.38
|
| Rate for Payer: Health Management Network Commercial |
$937.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$380.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$350.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$350.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.98
|
| Rate for Payer: University Health Alliance Commercial |
$460.82
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$532.86 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: AlohaCare Medicaid |
$593.33
|
| Rate for Payer: AlohaCare Medicare |
$532.86
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Devoted Health Medicare |
$586.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$532.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$583.44
|
| Rate for Payer: Health Management Network Commercial |
$863.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$639.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$639.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$639.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$593.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$532.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$593.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$532.86
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$711.88 |
| Max. Negotiated Rate |
$1,112.65 |
| Rate for Payer: AlohaCare Medicaid |
$763.58
|
| Rate for Payer: AlohaCare Medicare |
$716.59
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Devoted Health Medicare |
$788.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$716.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$711.88
|
| Rate for Payer: Health Management Network Commercial |
$1,112.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$859.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$859.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$716.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$763.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$716.59
|
|
|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$1,254.52
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$178.62 |
| Max. Negotiated Rate |
$1,066.34 |
| Rate for Payer: AlohaCare Medicaid |
$256.16
|
| Rate for Payer: AlohaCare Medicare |
$242.54
|
| Rate for Payer: Cash Price |
$752.71
|
| Rate for Payer: Cash Price |
$752.71
|
| Rate for Payer: Devoted Health Medicare |
$266.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$401.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$242.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.62
|
| Rate for Payer: Health Management Network Commercial |
$1,066.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$242.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$242.54
|
| Rate for Payer: University Health Alliance Commercial |
$343.79
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$507.78 |
| Max. Negotiated Rate |
$1,727.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,182.99
|
| Rate for Payer: AlohaCare Medicare |
$1,091.03
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Devoted Health Medicare |
$1,200.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,091.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.78
|
| Rate for Payer: Health Management Network Commercial |
$1,727.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,309.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,309.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,309.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,182.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,091.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,182.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,091.03
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH
|
Professional
|
Both
|
$3,147.00
|
|
|
Service Code
|
HCPCS 35820
|
| Min. Negotiated Rate |
$631.02 |
| Max. Negotiated Rate |
$2,674.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,909.22
|
| Rate for Payer: AlohaCare Medicare |
$1,798.10
|
| Rate for Payer: Cash Price |
$1,888.20
|
| Rate for Payer: Cash Price |
$1,888.20
|
| Rate for Payer: Devoted Health Medicare |
$1,977.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,798.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$631.02
|
| Rate for Payer: Health Management Network Commercial |
$2,674.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,157.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,157.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,157.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,909.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,798.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,909.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,798.10
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 35800
|
| Min. Negotiated Rate |
$362.96 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: AlohaCare Medicaid |
$730.77
|
| Rate for Payer: AlohaCare Medicare |
$654.79
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Devoted Health Medicare |
$720.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$654.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$362.96
|
| Rate for Payer: Health Management Network Commercial |
$1,065.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$785.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$785.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$785.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$730.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$654.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$730.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$654.79
|
|
