|
PR FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL
|
Professional
|
Both
|
$448.14
|
|
|
Service Code
|
HCPCS 10010
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$380.92 |
| Rate for Payer: AlohaCare Medicaid |
$69.17
|
| Rate for Payer: AlohaCare Medicare |
$63.53
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Devoted Health Medicare |
$69.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$124.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.98
|
| Rate for Payer: Health Management Network Commercial |
$380.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.53
|
| Rate for Payer: University Health Alliance Commercial |
$91.35
|
|
|
PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION
|
Professional
|
Both
|
$662.30
|
|
|
Service Code
|
HCPCS 10007
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$562.96 |
| Rate for Payer: AlohaCare Medicaid |
$88.07
|
| Rate for Payer: AlohaCare Medicare |
$78.06
|
| Rate for Payer: Cash Price |
$397.38
|
| Rate for Payer: Cash Price |
$397.38
|
| Rate for Payer: Devoted Health Medicare |
$85.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$88.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$141.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$88.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$321.10
|
| Rate for Payer: Health Management Network Commercial |
$562.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.06
|
| Rate for Payer: University Health Alliance Commercial |
$104.38
|
|
|
PR FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL
|
Professional
|
Both
|
$267.02
|
|
|
Service Code
|
HCPCS 10008
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$226.97 |
| Rate for Payer: AlohaCare Medicaid |
$49.35
|
| Rate for Payer: AlohaCare Medicare |
$45.49
|
| Rate for Payer: Cash Price |
$160.21
|
| Rate for Payer: Cash Price |
$160.21
|
| Rate for Payer: Devoted Health Medicare |
$50.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.92
|
| Rate for Payer: Health Management Network Commercial |
$226.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.49
|
| Rate for Payer: University Health Alliance Commercial |
$65.76
|
|
|
PR FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 10011
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$732.70 |
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$102.00
|
| Rate for Payer: Health Management Network Commercial |
$732.70
|
|
|
PR FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 10012
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.56
|
| Rate for Payer: Health Management Network Commercial |
$396.95
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$188.79
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$45.22 |
| Max. Negotiated Rate |
$160.47 |
| Rate for Payer: AlohaCare Medicaid |
$54.49
|
| Rate for Payer: AlohaCare Medicare |
$45.22
|
| Rate for Payer: Cash Price |
$113.27
|
| Rate for Payer: Cash Price |
$113.27
|
| Rate for Payer: Devoted Health Medicare |
$49.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$90.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.72
|
| Rate for Payer: Health Management Network Commercial |
$160.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.22
|
| Rate for Payer: University Health Alliance Commercial |
$59.40
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL
|
Professional
|
Both
|
$95.18
|
|
|
Service Code
|
HCPCS 10004
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$80.90 |
| Rate for Payer: AlohaCare Medicaid |
$42.83
|
| Rate for Payer: AlohaCare Medicare |
$35.78
|
| Rate for Payer: Cash Price |
$57.11
|
| Rate for Payer: Cash Price |
$57.11
|
| Rate for Payer: Devoted Health Medicare |
$39.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.38
|
| Rate for Payer: Health Management Network Commercial |
$80.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.78
|
| Rate for Payer: University Health Alliance Commercial |
$49.26
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$246.26
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: AlohaCare Medicaid |
$72.24
|
| Rate for Payer: AlohaCare Medicare |
$61.35
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Devoted Health Medicare |
$67.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$209.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.35
|
| Rate for Payer: University Health Alliance Commercial |
$78.33
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$108.18
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$91.95 |
| Rate for Payer: AlohaCare Medicaid |
$49.69
|
| Rate for Payer: AlohaCare Medicare |
$42.46
|
| Rate for Payer: Cash Price |
$64.91
|
| Rate for Payer: Cash Price |
$64.91
|
| Rate for Payer: Devoted Health Medicare |
$46.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.44
|
| Rate for Payer: Health Management Network Commercial |
$91.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.46
|
| Rate for Payer: University Health Alliance Commercial |
$53.59
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$2.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.68
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: AlohaCare Medicaid |
$45.24
|
| Rate for Payer: AlohaCare Medicare |
$39.18
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$43.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.94
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.18
|
| Rate for Payer: University Health Alliance Commercial |
$56.07
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 92242
|
| Min. Negotiated Rate |
$259.30 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: AlohaCare Medicaid |
$316.93
|
| Rate for Payer: AlohaCare Medicare |
$377.43
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Devoted Health Medicare |
$415.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$377.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.30
|
| Rate for Payer: Health Management Network Commercial |
$944.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$452.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$452.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$377.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$377.43
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 92242 TC
|
| Min. Negotiated Rate |
$259.30 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: AlohaCare Medicaid |
$316.93
|
| Rate for Payer: AlohaCare Medicare |
$321.10
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Devoted Health Medicare |
$353.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.30
|
| Rate for Payer: Health Management Network Commercial |
$860.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.10
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 92242 26
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$316.93 |
| Rate for Payer: AlohaCare Medicaid |
$316.93
|
| Rate for Payer: AlohaCare Medicare |
$56.33
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$61.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.30
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.33
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$129.27
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.34
|
| Rate for Payer: AlohaCare Medicare |
$49.56
|
| Rate for Payer: Cash Price |
$77.56
|
| Rate for Payer: Cash Price |
$77.56
|
| Rate for Payer: Devoted Health Medicare |
$54.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$109.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.56
|
| Rate for Payer: University Health Alliance Commercial |
$73.88
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: AlohaCare Medicaid |
$127.09
|
| Rate for Payer: AlohaCare Medicare |
$114.59
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Devoted Health Medicare |
$126.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.98
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.59
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$683.27
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: AlohaCare Medicaid |
$269.20
|
| Rate for Payer: AlohaCare Medicare |
$241.96
|
| Rate for Payer: Cash Price |
$409.96
|
| Rate for Payer: Cash Price |
$409.96
|
| Rate for Payer: Devoted Health Medicare |
$266.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$269.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$410.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$269.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.36
|
| Rate for Payer: Health Management Network Commercial |
$580.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$269.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.96
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: AlohaCare Medicaid |
$203.67
|
| Rate for Payer: AlohaCare Medicare |
$191.48
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Devoted Health Medicare |
$210.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.36
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.48
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,740.20
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$1,479.17 |
| Rate for Payer: AlohaCare Medicaid |
$835.06
|
| Rate for Payer: AlohaCare Medicare |
$722.48
|
| Rate for Payer: Cash Price |
$1,044.12
|
| Rate for Payer: Cash Price |
$1,044.12
|
| Rate for Payer: Devoted Health Medicare |
$794.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$835.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,273.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$722.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$835.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.84
|
| Rate for Payer: Health Management Network Commercial |
$1,479.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$866.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$866.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$866.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$835.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$722.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$835.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$722.48
|
| Rate for Payer: University Health Alliance Commercial |
$942.38
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,857.85
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$1,579.17 |
| Rate for Payer: AlohaCare Medicaid |
$884.63
|
| Rate for Payer: AlohaCare Medicare |
$750.78
|
| Rate for Payer: Cash Price |
$1,114.71
|
| Rate for Payer: Cash Price |
$1,114.71
|
| Rate for Payer: Devoted Health Medicare |
$825.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$884.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,350.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$884.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$686.40
|
| Rate for Payer: Health Management Network Commercial |
$1,579.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$900.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$900.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$884.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$884.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.78
|
| Rate for Payer: University Health Alliance Commercial |
$999.09
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,458.10
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$398.58 |
| Max. Negotiated Rate |
$1,239.38 |
| Rate for Payer: AlohaCare Medicaid |
$638.04
|
| Rate for Payer: AlohaCare Medicare |
$554.45
|
| Rate for Payer: Cash Price |
$874.86
|
| Rate for Payer: Cash Price |
$874.86
|
| Rate for Payer: Devoted Health Medicare |
$609.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$638.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$975.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$554.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$638.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.58
|
| Rate for Payer: Health Management Network Commercial |
$1,239.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$665.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$665.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$638.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$554.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$638.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$554.45
|
| Rate for Payer: University Health Alliance Commercial |
$721.56
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,622.22
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$381.42 |
| Max. Negotiated Rate |
$1,378.89 |
| Rate for Payer: AlohaCare Medicaid |
$696.83
|
| Rate for Payer: AlohaCare Medicare |
$619.37
|
| Rate for Payer: Cash Price |
$973.33
|
| Rate for Payer: Cash Price |
$973.33
|
| Rate for Payer: Devoted Health Medicare |
$681.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$696.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,070.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$619.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$696.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$381.42
|
| Rate for Payer: Health Management Network Commercial |
$1,378.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$743.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$743.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$743.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$619.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$696.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$619.37
|
| Rate for Payer: University Health Alliance Commercial |
$792.41
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$333.60
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$88.09 |
| Max. Negotiated Rate |
$283.56 |
| Rate for Payer: AlohaCare Medicaid |
$106.33
|
| Rate for Payer: AlohaCare Medicare |
$88.09
|
| Rate for Payer: Cash Price |
$200.16
|
| Rate for Payer: Cash Price |
$200.16
|
| Rate for Payer: Devoted Health Medicare |
$96.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$163.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.66
|
| Rate for Payer: Health Management Network Commercial |
$283.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.09
|
| Rate for Payer: University Health Alliance Commercial |
$121.13
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$250.69
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$213.09 |
| Rate for Payer: AlohaCare Medicaid |
$68.39
|
| Rate for Payer: AlohaCare Medicare |
$56.66
|
| Rate for Payer: Cash Price |
$150.41
|
| Rate for Payer: Cash Price |
$150.41
|
| Rate for Payer: Devoted Health Medicare |
$62.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$213.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.66
|
| Rate for Payer: University Health Alliance Commercial |
$79.45
|
|
|
PR FTH/GFT FR W/DIR CLSR TRUNK EA ADDL 20 SQ CM
|
Professional
|
Both
|
$277.25
|
|
|
Service Code
|
HCPCS 15201
|
| Min. Negotiated Rate |
$63.49 |
| Max. Negotiated Rate |
$235.66 |
| Rate for Payer: AlohaCare Medicaid |
$75.38
|
| Rate for Payer: AlohaCare Medicare |
$63.49
|
| Rate for Payer: Cash Price |
$166.35
|
| Rate for Payer: Cash Price |
$166.35
|
| Rate for Payer: Devoted Health Medicare |
$69.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.04
|
| Rate for Payer: Health Management Network Commercial |
$235.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.49
|
| Rate for Payer: University Health Alliance Commercial |
$87.11
|
|
