|
PR BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL
|
Professional
|
Both
|
$498.75
|
|
|
Service Code
|
HCPCS 21920
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$423.94 |
| Rate for Payer: AlohaCare Medicaid |
$161.69
|
| Rate for Payer: AlohaCare Medicare |
$146.76
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Devoted Health Medicare |
$161.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$161.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$250.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$161.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$423.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.76
|
| Rate for Payer: University Health Alliance Commercial |
$212.28
|
|
|
PR BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 25066
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: AlohaCare Medicaid |
$394.20
|
| Rate for Payer: AlohaCare Medicare |
$373.17
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Devoted Health Medicare |
$410.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$583.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$447.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$447.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$394.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$394.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.17
|
|
|
PR BIOPSY SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 21550
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: AlohaCare Medicaid |
$163.23
|
| Rate for Payer: AlohaCare Medicare |
$148.28
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Devoted Health Medicare |
$163.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$163.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$163.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.74
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.28
|
| Rate for Payer: University Health Alliance Commercial |
$212.78
|
|
|
PR BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 27324
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$432.30
|
| Rate for Payer: AlohaCare Medicare |
$414.09
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$455.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$414.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$496.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$496.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$432.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$414.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$432.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$414.09
|
|
|
PR BIOPSY THYROID PERCUTANEOUS CORE NEEDLE
|
Professional
|
Both
|
$198.28
|
|
|
Service Code
|
HCPCS 60100
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: AlohaCare Medicaid |
$75.37
|
| Rate for Payer: AlohaCare Medicare |
$64.31
|
| Rate for Payer: Cash Price |
$118.97
|
| Rate for Payer: Cash Price |
$118.97
|
| Rate for Payer: Devoted Health Medicare |
$70.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$118.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$168.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.31
|
| Rate for Payer: University Health Alliance Commercial |
$93.26
|
|
|
PR BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$356.91
|
|
|
Service Code
|
HCPCS 41100
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$303.37 |
| Rate for Payer: AlohaCare Medicaid |
$113.16
|
| Rate for Payer: AlohaCare Medicare |
$101.04
|
| Rate for Payer: Cash Price |
$214.15
|
| Rate for Payer: Cash Price |
$214.15
|
| Rate for Payer: Devoted Health Medicare |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$173.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$303.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.04
|
| Rate for Payer: University Health Alliance Commercial |
$145.25
|
|
|
PR BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$359.52
|
|
|
Service Code
|
HCPCS 41105
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$305.59 |
| Rate for Payer: AlohaCare Medicaid |
$116.35
|
| Rate for Payer: AlohaCare Medicare |
$104.04
|
| Rate for Payer: Cash Price |
$215.71
|
| Rate for Payer: Cash Price |
$215.71
|
| Rate for Payer: Devoted Health Medicare |
$114.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$177.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.26
|
| Rate for Payer: Health Management Network Commercial |
$305.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.04
|
| Rate for Payer: University Health Alliance Commercial |
$150.25
|
|
|
PR BIOPSY URETHRA
|
Professional
|
Both
|
$297.66
|
|
|
Service Code
|
HCPCS 53200
|
| Min. Negotiated Rate |
$126.79 |
| Max. Negotiated Rate |
$253.01 |
| Rate for Payer: AlohaCare Medicaid |
$142.09
|
| Rate for Payer: AlohaCare Medicare |
$126.79
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Devoted Health Medicare |
$139.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.78
|
| Rate for Payer: Health Management Network Commercial |
$253.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.79
|
| Rate for Payer: University Health Alliance Commercial |
$185.55
|
|
|
PR BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$192.80
|
|
|
Service Code
|
HCPCS 57100
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$163.88 |
| Rate for Payer: AlohaCare Medicaid |
$65.10
|
| Rate for Payer: AlohaCare Medicare |
$57.01
|
| Rate for Payer: Cash Price |
$115.68
|
| Rate for Payer: Cash Price |
$115.68
|
| Rate for Payer: Devoted Health Medicare |
$62.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$101.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$163.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.01
|
| Rate for Payer: University Health Alliance Commercial |
$86.32
|
|
|
PR BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$321.56
|
|
|
Service Code
|
HCPCS 40808
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$273.33 |
| Rate for Payer: AlohaCare Medicaid |
$95.13
|
| Rate for Payer: AlohaCare Medicare |
$86.53
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: Devoted Health Medicare |
$95.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$95.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$152.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$95.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$273.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.53
|
| Rate for Payer: University Health Alliance Commercial |
$150.00
|
|
|
PR BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$171.99
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$146.19 |
| Rate for Payer: AlohaCare Medicaid |
$58.72
|
| Rate for Payer: AlohaCare Medicare |
$50.43
|
| Rate for Payer: Cash Price |
$103.19
|
| Rate for Payer: Cash Price |
$103.19
|
| Rate for Payer: Devoted Health Medicare |
$55.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$146.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.43
|
| Rate for Payer: University Health Alliance Commercial |
$125.00
|
|
|
PR BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$70.49
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$59.92 |
| Rate for Payer: AlohaCare Medicaid |
$28.79
|
| Rate for Payer: AlohaCare Medicare |
$24.71
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: Devoted Health Medicare |
$27.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network Commercial |
$59.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.71
|
| Rate for Payer: University Health Alliance Commercial |
$38.14
|
|
|
PR BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Professional
|
Both
|
$172.38
|
|
|
Service Code
|
HCPCS 51720
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: AlohaCare Medicaid |
$42.87
|
| Rate for Payer: AlohaCare Medicare |
$37.35
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Devoted Health Medicare |
$41.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$146.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.35
|
| Rate for Payer: University Health Alliance Commercial |
$56.65
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 51726
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$740.35 |
| Rate for Payer: AlohaCare Medicaid |
$332.80
|
| Rate for Payer: AlohaCare Medicare |
$297.18
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Devoted Health Medicare |
$326.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.14
|
| Rate for Payer: Health Management Network Commercial |
$740.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.18
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
HCPCS 51726 TC
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: AlohaCare Medicaid |
$332.80
|
| Rate for Payer: AlohaCare Medicare |
$211.92
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Devoted Health Medicare |
$233.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.14
|
| Rate for Payer: Health Management Network Commercial |
$613.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.92
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 51726 26
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: AlohaCare Medicaid |
$332.80
|
| Rate for Payer: AlohaCare Medicare |
$85.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Devoted Health Medicare |
$93.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.14
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.26
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$148.50
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Devoted Health Medicare |
$28.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.64
|
| Rate for Payer: Health Management Network Commercial |
$126.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$39.85
|
|
|
PR BLEPHAROPLASTY LOWER EYELID
|
Professional
|
Both
|
$1,105.77
|
|
|
Service Code
|
HCPCS 15820
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: AlohaCare Medicaid |
$551.38
|
| Rate for Payer: AlohaCare Medicare |
$475.40
|
| Rate for Payer: Cash Price |
$663.46
|
| Rate for Payer: Cash Price |
$663.46
|
| Rate for Payer: Devoted Health Medicare |
$522.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$551.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$551.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.30
|
| Rate for Payer: Health Management Network Commercial |
$939.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$570.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$570.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$551.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$551.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.40
|
| Rate for Payer: University Health Alliance Commercial |
$620.30
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$1,187.44
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$385.58 |
| Max. Negotiated Rate |
$1,009.32 |
| Rate for Payer: AlohaCare Medicaid |
$585.01
|
| Rate for Payer: AlohaCare Medicare |
$507.27
|
| Rate for Payer: Cash Price |
$712.46
|
| Rate for Payer: Cash Price |
$712.46
|
| Rate for Payer: Devoted Health Medicare |
$558.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$585.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$585.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$385.58
|
| Rate for Payer: Health Management Network Commercial |
$1,009.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$585.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$585.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.27
|
| Rate for Payer: University Health Alliance Commercial |
$661.92
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$544.37
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$462.71 |
| Rate for Payer: AlohaCare Medicaid |
$123.62
|
| Rate for Payer: AlohaCare Medicare |
$108.27
|
| Rate for Payer: Cash Price |
$326.62
|
| Rate for Payer: Cash Price |
$326.62
|
| Rate for Payer: Devoted Health Medicare |
$119.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$187.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$462.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.27
|
| Rate for Payer: University Health Alliance Commercial |
$158.34
|
|
|
PR BLUE LIGHT CYSTO IMAG AGENT
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS C9738
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$239.03 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: AlohaCare Medicaid |
$275.04
|
| Rate for Payer: AlohaCare Medicare |
$239.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Devoted Health Medicare |
$262.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.62
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$286.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.03
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$753.74
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$640.68 |
| Rate for Payer: AlohaCare Medicaid |
$181.49
|
| Rate for Payer: AlohaCare Medicare |
$160.31
|
| Rate for Payer: Cash Price |
$452.24
|
| Rate for Payer: Cash Price |
$452.24
|
| Rate for Payer: Devoted Health Medicare |
$176.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$605.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$181.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.88
|
| Rate for Payer: Health Management Network Commercial |
$640.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.31
|
| Rate for Payer: University Health Alliance Commercial |
$240.53
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$563.68 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: AlohaCare Medicaid |
$640.04
|
| Rate for Payer: AlohaCare Medicare |
$579.88
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Devoted Health Medicare |
$637.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$579.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$563.68
|
| Rate for Payer: Health Management Network Commercial |
$935.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$695.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$695.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$695.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$640.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$579.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$640.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$579.88
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$3,757.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,549.08 |
| Max. Negotiated Rate |
$3,193.45 |
| Rate for Payer: AlohaCare Medicaid |
$2,187.95
|
| Rate for Payer: AlohaCare Medicare |
$1,879.07
|
| Rate for Payer: Cash Price |
$2,254.20
|
| Rate for Payer: Cash Price |
$2,254.20
|
| Rate for Payer: Devoted Health Medicare |
$2,066.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,879.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,549.08
|
| Rate for Payer: Health Management Network Commercial |
$3,193.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,254.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,254.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,254.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,187.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,879.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,187.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,879.07
|
|
