|
PRIMIDONE 50 MG TABLET [11129]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084020201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
PRIMIDONE 50 MG TABLET [11129]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084020201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
PRIMIDONE 50 MG TABLET [11129]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 53746054401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PRIMIDONE 50 MG TABLET [11129]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 53746054401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.52
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.52
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PR IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 90480
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
|
|
PR IMM CNSL PHYS/QHP IMM NOT ADMN SAME DOS 3<10 MIN
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90482
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
|
|
PR IMPL ABSRB MESH/PRSTH DLYD CLSR DFCT INFCTJ/TRMA
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 15778
|
| Min. Negotiated Rate |
$338.67 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: AlohaCare Medicaid |
$372.79
|
| Rate for Payer: AlohaCare Medicare |
$338.67
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.67
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$406.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$406.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$372.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.67
|
|
|
PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT
|
Professional
|
Both
|
$395.59
|
|
|
Service Code
|
HCPCS 15777
|
| Min. Negotiated Rate |
$178.58 |
| Max. Negotiated Rate |
$336.25 |
| Rate for Payer: AlohaCare Medicaid |
$211.64
|
| Rate for Payer: AlohaCare Medicare |
$178.58
|
| Rate for Payer: Cash Price |
$237.35
|
| Rate for Payer: Cash Price |
$237.35
|
| Rate for Payer: Devoted Health Medicare |
$196.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.72
|
| Rate for Payer: Health Management Network Commercial |
$336.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$211.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.58
|
|
|
PR IMPLTJ NONBIOL/SYNTH IMPLT FASC RNFCMT ABDL WALL
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
HCPCS 0437T
|
| Min. Negotiated Rate |
$406.30 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Health Management Network Commercial |
$406.30
|
|
|
PR INCISIONAL BIOPSY EYELID SKIN W/LID MARGIN
|
Professional
|
Both
|
$347.41
|
|
|
Service Code
|
HCPCS 67810
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$295.30 |
| Rate for Payer: AlohaCare Medicaid |
$68.87
|
| Rate for Payer: AlohaCare Medicare |
$55.35
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Devoted Health Medicare |
$60.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$113.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.35
|
| Rate for Payer: University Health Alliance Commercial |
$90.31
|
|
|
PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$134.70
|
|
|
Service Code
|
HCPCS 11107
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$114.50 |
| Rate for Payer: AlohaCare Medicaid |
$30.76
|
| Rate for Payer: AlohaCare Medicare |
$24.94
|
| Rate for Payer: Cash Price |
$80.82
|
| Rate for Payer: Cash Price |
$80.82
|
| Rate for Payer: Devoted Health Medicare |
$27.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.08
|
| Rate for Payer: Health Management Network Commercial |
$114.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.94
|
| Rate for Payer: University Health Alliance Commercial |
$35.94
|
|
|
PR INCISIONAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$289.29
|
|
|
Service Code
|
HCPCS 11106
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$245.90 |
| Rate for Payer: AlohaCare Medicaid |
$56.70
|
| Rate for Payer: AlohaCare Medicare |
$46.07
|
| Rate for Payer: Cash Price |
$173.57
|
| Rate for Payer: Cash Price |
$173.57
|
| Rate for Payer: Devoted Health Medicare |
$50.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$167.96
|
| Rate for Payer: Health Management Network Commercial |
$245.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.07
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
PR INCISION BONE CORTEX HAND/FINGER
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 26034
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: AlohaCare Medicaid |
$588.07
|
| Rate for Payer: AlohaCare Medicare |
$545.09
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Devoted Health Medicare |
$599.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$545.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$371.80
|
| Rate for Payer: Health Management Network Commercial |
$861.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$654.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$654.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$654.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$588.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$545.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$588.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$545.09
|
|
|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
Both
|
$408.06
|
|
|
Service Code
|
HCPCS 10061
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$346.85 |
| Rate for Payer: AlohaCare Medicaid |
$194.24
|
| Rate for Payer: AlohaCare Medicare |
$180.01
|
| Rate for Payer: Cash Price |
$244.84
|
| Rate for Payer: Cash Price |
$244.84
|
| Rate for Payer: Devoted Health Medicare |
$198.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$346.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.01
|
| Rate for Payer: University Health Alliance Commercial |
$209.93
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$242.10
|
|
|
Service Code
|
HCPCS 10060
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$205.78 |
| Rate for Payer: AlohaCare Medicaid |
$114.56
|
| Rate for Payer: AlohaCare Medicare |
$106.44
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Devoted Health Medicare |
$117.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$168.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$114.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.56
|
| Rate for Payer: Health Management Network Commercial |
$205.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.44
|
|
|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$311.48
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$264.76 |
| Rate for Payer: AlohaCare Medicaid |
$96.14
|
| Rate for Payer: AlohaCare Medicare |
$86.46
|
| Rate for Payer: Cash Price |
$186.89
|
| Rate for Payer: Cash Price |
$186.89
|
| Rate for Payer: Devoted Health Medicare |
$95.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$264.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.46
|
| Rate for Payer: University Health Alliance Commercial |
$127.57
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$539.30
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$458.40 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$323.58
|
| Rate for Payer: Cash Price |
$323.58
|
| Rate for Payer: Devoted Health Medicare |
$198.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$458.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$578.85 |
| Rate for Payer: AlohaCare Medicaid |
$395.75
|
| Rate for Payer: AlohaCare Medicare |
$378.37
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Devoted Health Medicare |
$416.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$378.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$578.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$454.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$378.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$395.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$378.37
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,013.11
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$275.86 |
| Max. Negotiated Rate |
$861.14 |
| Rate for Payer: AlohaCare Medicaid |
$407.55
|
| Rate for Payer: AlohaCare Medicare |
$381.82
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Cash Price |
$607.87
|
| Rate for Payer: Devoted Health Medicare |
$420.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$407.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$632.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$381.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.86
|
| Rate for Payer: Health Management Network Commercial |
$861.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$458.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$458.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$458.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$407.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$381.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$407.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$381.82
|
| Rate for Payer: University Health Alliance Commercial |
$505.35
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$721.10
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$612.93 |
| Rate for Payer: AlohaCare Medicaid |
$175.37
|
| Rate for Payer: AlohaCare Medicare |
$171.67
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Devoted Health Medicare |
$188.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$175.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$272.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$175.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.54
|
| Rate for Payer: Health Management Network Commercial |
$612.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$175.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.67
|
| Rate for Payer: University Health Alliance Commercial |
$201.59
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$520.28
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$442.24 |
| Rate for Payer: Kaiser Permanente Medicare |
$132.54
|
| Rate for Payer: AlohaCare Medicaid |
$111.66
|
| Rate for Payer: AlohaCare Medicare |
$110.45
|
| Rate for Payer: Cash Price |
$312.17
|
| Rate for Payer: Cash Price |
$312.17
|
| Rate for Payer: Devoted Health Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$168.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$442.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.45
|
| Rate for Payer: University Health Alliance Commercial |
$120.86
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$618.90
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$526.07 |
| Rate for Payer: AlohaCare Medicaid |
$172.20
|
| Rate for Payer: AlohaCare Medicare |
$165.68
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Devoted Health Medicare |
$182.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$261.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$526.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.68
|
| Rate for Payer: University Health Alliance Commercial |
$221.37
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$311.22 |
| Max. Negotiated Rate |
$552.50 |
| Rate for Payer: AlohaCare Medicaid |
$377.56
|
| Rate for Payer: AlohaCare Medicare |
$358.85
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$394.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$311.22
|
| Rate for Payer: Health Management Network Commercial |
$552.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$377.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.85
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$197.02
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$167.47 |
| Rate for Payer: AlohaCare Medicaid |
$31.52
|
| Rate for Payer: AlohaCare Medicare |
$30.17
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Cash Price |
$118.21
|
| Rate for Payer: Devoted Health Medicare |
$33.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.88
|
| Rate for Payer: Health Management Network Commercial |
$167.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.17
|
| Rate for Payer: University Health Alliance Commercial |
$65.00
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$406.16
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$345.24 |
| Rate for Payer: AlohaCare Medicaid |
$118.73
|
| Rate for Payer: AlohaCare Medicare |
$108.66
|
| Rate for Payer: Cash Price |
$243.70
|
| Rate for Payer: Cash Price |
$243.70
|
| Rate for Payer: Devoted Health Medicare |
$119.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network Commercial |
$345.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.66
|
| Rate for Payer: University Health Alliance Commercial |
$250.00
|
|
