|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$2,472.70
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$200.38 |
| Max. Negotiated Rate |
$2,101.80 |
| Rate for Payer: AlohaCare Medicaid |
$230.09
|
| Rate for Payer: AlohaCare Medicare |
$200.38
|
| Rate for Payer: Cash Price |
$1,483.62
|
| Rate for Payer: Cash Price |
$1,483.62
|
| Rate for Payer: Devoted Health Medicare |
$220.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$230.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$358.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$230.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$2,101.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.38
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: AlohaCare Medicaid |
$309.91
|
| Rate for Payer: AlohaCare Medicare |
$268.24
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Devoted Health Medicare |
$295.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.70
|
| Rate for Payer: Health Management Network Commercial |
$447.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.24
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$3,940.51
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$212.36 |
| Max. Negotiated Rate |
$3,349.43 |
| Rate for Payer: AlohaCare Medicaid |
$244.27
|
| Rate for Payer: AlohaCare Medicare |
$212.36
|
| Rate for Payer: Cash Price |
$2,364.31
|
| Rate for Payer: Cash Price |
$2,364.31
|
| Rate for Payer: Devoted Health Medicare |
$233.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$444.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$244.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$355.68
|
| Rate for Payer: Health Management Network Commercial |
$3,349.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.36
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$740.11
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$191.26 |
| Max. Negotiated Rate |
$629.09 |
| Rate for Payer: AlohaCare Medicaid |
$220.43
|
| Rate for Payer: AlohaCare Medicare |
$191.26
|
| Rate for Payer: Cash Price |
$444.07
|
| Rate for Payer: Cash Price |
$444.07
|
| Rate for Payer: Devoted Health Medicare |
$210.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$220.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$377.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$220.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.44
|
| Rate for Payer: Health Management Network Commercial |
$629.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$229.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$220.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.26
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$306.08 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: AlohaCare Medicaid |
$354.39
|
| Rate for Payer: AlohaCare Medicare |
$306.08
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Devoted Health Medicare |
$336.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$550.16
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$367.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$367.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$367.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.08
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.52
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$374.57
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$318.38 |
| Rate for Payer: AlohaCare Medicaid |
$144.40
|
| Rate for Payer: AlohaCare Medicare |
$133.53
|
| Rate for Payer: Cash Price |
$224.74
|
| Rate for Payer: Cash Price |
$224.74
|
| Rate for Payer: Devoted Health Medicare |
$146.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$219.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.72
|
| Rate for Payer: Health Management Network Commercial |
$318.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.53
|
| Rate for Payer: University Health Alliance Commercial |
$274.00
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL
|
Professional
|
Both
|
$809.64
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$688.19 |
| Rate for Payer: AlohaCare Medicaid |
$394.56
|
| Rate for Payer: AlohaCare Medicare |
$334.67
|
| Rate for Payer: Cash Price |
$485.78
|
| Rate for Payer: Cash Price |
$485.78
|
| Rate for Payer: Devoted Health Medicare |
$368.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$394.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$612.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$394.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.72
|
| Rate for Payer: Health Management Network Commercial |
$688.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$401.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$401.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$394.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$394.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.67
|
| Rate for Payer: University Health Alliance Commercial |
$518.49
|
|
|
PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$451.90
|
|
|
Service Code
|
HCPCS 28002
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AlohaCare Medicaid |
$141.53
|
| Rate for Payer: AlohaCare Medicare |
$127.59
|
| Rate for Payer: Cash Price |
$271.14
|
| Rate for Payer: Cash Price |
$271.14
|
| Rate for Payer: Devoted Health Medicare |
$140.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$384.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.59
|
| Rate for Payer: University Health Alliance Commercial |
$516.00
|
|
|
PR I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$684.16
|
|
|
Service Code
|
HCPCS 28003
|
| Min. Negotiated Rate |
$228.79 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: AlohaCare Medicaid |
$257.54
|
| Rate for Payer: AlohaCare Medicare |
$228.79
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Devoted Health Medicare |
$251.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$257.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$792.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$257.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.18
|
| Rate for Payer: Health Management Network Commercial |
$581.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$274.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$274.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$257.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.79
|
| Rate for Payer: University Health Alliance Commercial |
$793.00
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$1,332.98
|
|
|
Service Code
|
HCPCS 27301
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$1,133.03 |
| Rate for Payer: AlohaCare Medicaid |
$530.44
|
| Rate for Payer: AlohaCare Medicare |
$494.34
|
| Rate for Payer: Cash Price |
$799.79
|
| Rate for Payer: Cash Price |
$799.79
|
| Rate for Payer: Devoted Health Medicare |
$543.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$530.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$814.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$494.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$530.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$1,133.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$593.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$593.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$593.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$530.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$494.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$530.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$494.34
|
| Rate for Payer: University Health Alliance Commercial |
$689.50
|
|
|
PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 22010
|
| Min. Negotiated Rate |
$949.96 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: AlohaCare Medicaid |
$989.07
|
| Rate for Payer: AlohaCare Medicare |
$949.96
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Devoted Health Medicare |
$1,044.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$949.96
|
| Rate for Payer: Health Management Network Commercial |
$1,445.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,139.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,139.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$989.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$949.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$989.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$949.96
|
|
|
PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 21501
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: AlohaCare Medicaid |
$356.25
|
| Rate for Payer: AlohaCare Medicare |
$339.33
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Devoted Health Medicare |
$373.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$356.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$540.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$356.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.34
|
| Rate for Payer: Health Management Network Commercial |
$825.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$407.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$407.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$356.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$356.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.33
|
| Rate for Payer: University Health Alliance Commercial |
$457.81
|
|
|
PR I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 54700
|
| Min. Negotiated Rate |
$203.07 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$218.76
|
| Rate for Payer: AlohaCare Medicare |
$203.07
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Devoted Health Medicare |
$223.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.16
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$243.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.07
|
|
|
PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,292.71
|
|
|
Service Code
|
HCPCS 25028
|
| Min. Negotiated Rate |
$254.02 |
| Max. Negotiated Rate |
$1,098.80 |
| Rate for Payer: AlohaCare Medicaid |
$755.13
|
| Rate for Payer: AlohaCare Medicare |
$738.31
|
| Rate for Payer: Cash Price |
$775.63
|
| Rate for Payer: Cash Price |
$775.63
|
| Rate for Payer: Devoted Health Medicare |
$812.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$738.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.02
|
| Rate for Payer: Health Management Network Commercial |
$1,098.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$885.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$885.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$885.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$755.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$738.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$755.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$738.31
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$327.74
|
|
|
Service Code
|
HCPCS 10140
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$278.58 |
| Rate for Payer: AlohaCare Medicaid |
$124.60
|
| Rate for Payer: AlohaCare Medicare |
$120.44
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Devoted Health Medicare |
$132.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$278.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.44
|
| Rate for Payer: University Health Alliance Commercial |
$140.50
|
|
|
PR I&D INTRAMURAL IM/ABSC TRANSANAL ANES
|
Professional
|
Both
|
$804.65
|
|
|
Service Code
|
HCPCS 46045
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$683.95 |
| Rate for Payer: AlohaCare Medicaid |
$456.47
|
| Rate for Payer: AlohaCare Medicare |
$459.42
|
| Rate for Payer: Cash Price |
$482.79
|
| Rate for Payer: Cash Price |
$482.79
|
| Rate for Payer: Devoted Health Medicare |
$505.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$459.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$183.56
|
| Rate for Payer: Health Management Network Commercial |
$683.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$551.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$551.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$551.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$456.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$459.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$459.42
|
|
|
PR I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON
|
Professional
|
Both
|
$889.42
|
|
|
Service Code
|
HCPCS 46060
|
| Min. Negotiated Rate |
$427.70 |
| Max. Negotiated Rate |
$756.01 |
| Rate for Payer: AlohaCare Medicaid |
$508.11
|
| Rate for Payer: AlohaCare Medicare |
$508.24
|
| Rate for Payer: Cash Price |
$533.65
|
| Rate for Payer: Cash Price |
$533.65
|
| Rate for Payer: Devoted Health Medicare |
$559.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$508.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$427.70
|
| Rate for Payer: Health Management Network Commercial |
$756.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$609.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$609.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$508.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$508.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$508.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$508.24
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$1,172.99
|
|
|
Service Code
|
HCPCS 46040
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$997.04 |
| Rate for Payer: AlohaCare Medicaid |
$443.86
|
| Rate for Payer: AlohaCare Medicare |
$448.12
|
| Rate for Payer: Cash Price |
$703.79
|
| Rate for Payer: Cash Price |
$703.79
|
| Rate for Payer: Devoted Health Medicare |
$492.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$443.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$683.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$443.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$997.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$537.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$537.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$537.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$443.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.12
|
| Rate for Payer: University Health Alliance Commercial |
$555.80
|
|
|
PR I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$343.16
|
|
|
Service Code
|
HCPCS 56420
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$291.69 |
| Rate for Payer: AlohaCare Medicaid |
$116.29
|
| Rate for Payer: AlohaCare Medicare |
$103.05
|
| Rate for Payer: Cash Price |
$205.90
|
| Rate for Payer: Cash Price |
$205.90
|
| Rate for Payer: Devoted Health Medicare |
$113.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$159.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.50
|
| Rate for Payer: Health Management Network Commercial |
$291.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.05
|
| Rate for Payer: University Health Alliance Commercial |
$153.72
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$1,040.40 |
| Rate for Payer: AlohaCare Medicaid |
$718.45
|
| Rate for Payer: AlohaCare Medicare |
$684.41
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Devoted Health Medicare |
$752.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$684.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$232.44
|
| Rate for Payer: Health Management Network Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$821.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$821.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$821.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$684.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$718.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$684.41
|
|
|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: AlohaCare Medicaid |
$309.31
|
| Rate for Payer: AlohaCare Medicare |
$278.97
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$306.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$334.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$334.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.97
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$514.15
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$437.03 |
| Rate for Payer: AlohaCare Medicaid |
$106.57
|
| Rate for Payer: AlohaCare Medicare |
$107.72
|
| Rate for Payer: Cash Price |
$308.49
|
| Rate for Payer: Cash Price |
$308.49
|
| Rate for Payer: Devoted Health Medicare |
$118.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$162.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.88
|
| Rate for Payer: Health Management Network Commercial |
$437.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.72
|
| Rate for Payer: University Health Alliance Commercial |
$150.00
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$893.16
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$759.19 |
| Rate for Payer: AlohaCare Medicaid |
$264.74
|
| Rate for Payer: AlohaCare Medicare |
$248.72
|
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Cash Price |
$535.90
|
| Rate for Payer: Devoted Health Medicare |
$273.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$264.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$408.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$264.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$759.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.72
|
| Rate for Payer: University Health Alliance Commercial |
$346.19
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: AlohaCare Medicaid |
$233.94
|
| Rate for Payer: AlohaCare Medicare |
$222.26
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$244.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$233.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$353.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$233.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.26
|
| Rate for Payer: University Health Alliance Commercial |
$299.00
|
|
