|
PR DOPPLER ECHO PULSE WAVE W/SPECTRAL F-UP/LMTD STD
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 93321 26
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$59.01 |
| Rate for Payer: AlohaCare Medicaid |
$27.75
|
| Rate for Payer: AlohaCare Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$8.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.01
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.48
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH
|
Professional
|
Both
|
$502.67
|
|
|
Service Code
|
HCPCS 30000
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$427.27 |
| Rate for Payer: AlohaCare Medicaid |
$128.72
|
| Rate for Payer: AlohaCare Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Devoted Health Medicare |
$126.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$128.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$195.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$128.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$427.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$128.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$165.86
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM
|
Professional
|
Both
|
$513.29
|
|
|
Service Code
|
HCPCS 30020
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: AlohaCare Medicaid |
$130.63
|
| Rate for Payer: AlohaCare Medicare |
$116.34
|
| Rate for Payer: Cash Price |
$307.97
|
| Rate for Payer: Cash Price |
$307.97
|
| Rate for Payer: Devoted Health Medicare |
$127.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.84
|
| Rate for Payer: Health Management Network Commercial |
$436.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.34
|
| Rate for Payer: University Health Alliance Commercial |
$167.67
|
|
|
PR DRAINAGE ABSCESS PALATE UVULA
|
Professional
|
Both
|
$302.45
|
|
|
Service Code
|
HCPCS 42000
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$257.08 |
| Rate for Payer: AlohaCare Medicaid |
$116.53
|
| Rate for Payer: AlohaCare Medicare |
$103.72
|
| Rate for Payer: Cash Price |
$181.47
|
| Rate for Payer: Cash Price |
$181.47
|
| Rate for Payer: Devoted Health Medicare |
$114.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.66
|
| Rate for Payer: Health Management Network Commercial |
$257.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.72
|
| Rate for Payer: University Health Alliance Commercial |
$148.36
|
|
|
PR DRAINAGE ABSCESS PAROTID SIMPLE
|
Professional
|
Both
|
$403.39
|
|
|
Service Code
|
HCPCS 42300
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$342.88 |
| Rate for Payer: AlohaCare Medicaid |
$165.80
|
| Rate for Payer: AlohaCare Medicare |
$147.34
|
| Rate for Payer: Cash Price |
$242.03
|
| Rate for Payer: Cash Price |
$242.03
|
| Rate for Payer: Devoted Health Medicare |
$162.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$252.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.56
|
| Rate for Payer: Health Management Network Commercial |
$342.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.34
|
| Rate for Payer: University Health Alliance Commercial |
$213.45
|
|
|
PR DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL
|
Professional
|
Both
|
$490.23
|
|
|
Service Code
|
HCPCS 42320
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$416.70 |
| Rate for Payer: AlohaCare Medicaid |
$188.93
|
| Rate for Payer: AlohaCare Medicare |
$166.96
|
| Rate for Payer: Cash Price |
$294.14
|
| Rate for Payer: Cash Price |
$294.14
|
| Rate for Payer: Devoted Health Medicare |
$183.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$188.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$288.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$188.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.14
|
| Rate for Payer: Health Management Network Commercial |
$416.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.96
|
| Rate for Payer: University Health Alliance Commercial |
$244.22
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA COMP
|
Professional
|
Both
|
$415.62
|
|
|
Service Code
|
HCPCS 69005
|
| Min. Negotiated Rate |
$132.86 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: AlohaCare Medicaid |
$169.86
|
| Rate for Payer: AlohaCare Medicare |
$150.53
|
| Rate for Payer: Cash Price |
$249.37
|
| Rate for Payer: Cash Price |
$249.37
|
| Rate for Payer: Devoted Health Medicare |
$165.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.86
|
| Rate for Payer: Health Management Network Commercial |
$353.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.53
|
| Rate for Payer: University Health Alliance Commercial |
$218.91
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$362.28
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$307.94 |
| Rate for Payer: AlohaCare Medicaid |
$133.40
|
| Rate for Payer: AlohaCare Medicare |
$122.71
|
| Rate for Payer: Cash Price |
$217.37
|
| Rate for Payer: Cash Price |
$217.37
|
| Rate for Payer: Devoted Health Medicare |
$134.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$199.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$307.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.71
|
| Rate for Payer: University Health Alliance Commercial |
$170.87
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$997.97
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$848.27 |
| Rate for Payer: AlohaCare Medicaid |
$196.20
|
| Rate for Payer: AlohaCare Medicare |
$189.36
|
| Rate for Payer: Cash Price |
$598.78
|
| Rate for Payer: Cash Price |
$598.78
|
| Rate for Payer: Devoted Health Medicare |
$208.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$196.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$301.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$196.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$848.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$227.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$196.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.36
|
| Rate for Payer: University Health Alliance Commercial |
$255.47
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$724.80
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$616.08 |
| Rate for Payer: AlohaCare Medicaid |
$151.29
|
| Rate for Payer: AlohaCare Medicare |
$152.51
|
| Rate for Payer: Cash Price |
$434.88
|
| Rate for Payer: Cash Price |
$434.88
|
| Rate for Payer: Devoted Health Medicare |
$167.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$616.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.51
|
| Rate for Payer: University Health Alliance Commercial |
$191.92
|
|
|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$517.40 |
| Max. Negotiated Rate |
$1,589.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,080.98
|
| Rate for Payer: AlohaCare Medicare |
$1,004.94
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Devoted Health Medicare |
$1,105.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,004.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$517.40
|
| Rate for Payer: Health Management Network Commercial |
$1,589.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,205.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,205.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,205.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,080.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,004.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,080.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,004.94
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,691.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$842.92 |
| Max. Negotiated Rate |
$2,287.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,572.25
|
| Rate for Payer: AlohaCare Medicare |
$1,454.73
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Devoted Health Medicare |
$1,600.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,454.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.92
|
| Rate for Payer: Health Management Network Commercial |
$2,287.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,745.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,745.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,745.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,572.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,454.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,572.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,454.73
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$462.26
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$392.92 |
| Rate for Payer: AlohaCare Medicaid |
$174.72
|
| Rate for Payer: AlohaCare Medicare |
$168.45
|
| Rate for Payer: Cash Price |
$277.36
|
| Rate for Payer: Cash Price |
$277.36
|
| Rate for Payer: Devoted Health Medicare |
$185.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$392.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.45
|
| Rate for Payer: University Health Alliance Commercial |
$269.00
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$304.72 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: AlohaCare Medicaid |
$591.02
|
| Rate for Payer: AlohaCare Medicare |
$550.03
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Devoted Health Medicare |
$605.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$550.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$304.72
|
| Rate for Payer: Health Management Network Commercial |
$864.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$660.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$660.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$660.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$591.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$550.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$591.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$550.03
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: AlohaCare Medicaid |
$43.86
|
| Rate for Payer: AlohaCare Medicare |
$37.97
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$41.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.76
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.97
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$745.20
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$633.42 |
| Rate for Payer: AlohaCare Medicaid |
$167.63
|
| Rate for Payer: AlohaCare Medicare |
$204.43
|
| Rate for Payer: Cash Price |
$447.12
|
| Rate for Payer: Cash Price |
$447.12
|
| Rate for Payer: Devoted Health Medicare |
$224.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$167.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$249.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$167.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.04
|
| Rate for Payer: Health Management Network Commercial |
$633.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$167.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.43
|
| Rate for Payer: University Health Alliance Commercial |
$213.94
|
|
|
PR DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL
|
Professional
|
Both
|
$344.45
|
|
|
Service Code
|
HCPCS 42310
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: AlohaCare Medicaid |
$144.35
|
| Rate for Payer: AlohaCare Medicare |
$134.17
|
| Rate for Payer: Cash Price |
$206.67
|
| Rate for Payer: Cash Price |
$206.67
|
| Rate for Payer: Devoted Health Medicare |
$147.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.64
|
| Rate for Payer: Health Management Network Commercial |
$292.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.17
|
| Rate for Payer: University Health Alliance Commercial |
$186.52
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: AlohaCare Medicaid |
$506.91
|
| Rate for Payer: AlohaCare Medicare |
$496.42
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Devoted Health Medicare |
$546.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$496.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$200.72
|
| Rate for Payer: Health Management Network Commercial |
$739.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$595.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$595.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$496.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$506.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$496.42
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$715.33
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$608.03 |
| Rate for Payer: AlohaCare Medicaid |
$219.80
|
| Rate for Payer: AlohaCare Medicare |
$223.82
|
| Rate for Payer: Cash Price |
$429.20
|
| Rate for Payer: Cash Price |
$429.20
|
| Rate for Payer: Devoted Health Medicare |
$246.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$219.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$296.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$219.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.34
|
| Rate for Payer: Health Management Network Commercial |
$608.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$219.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.82
|
| Rate for Payer: University Health Alliance Commercial |
$288.33
|
|
|
PR DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN
|
Professional
|
Both
|
$1,310.00
|
|
|
Service Code
|
HCPCS 49062
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: AlohaCare Medicaid |
$764.31
|
| Rate for Payer: AlohaCare Medicare |
$720.20
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Devoted Health Medicare |
$792.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$720.20
|
| Rate for Payer: Health Management Network Commercial |
$1,113.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$864.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$864.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$764.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$764.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.20
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$395.06
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$335.80 |
| Rate for Payer: AlohaCare Medicaid |
$132.54
|
| Rate for Payer: AlohaCare Medicare |
$122.45
|
| Rate for Payer: Cash Price |
$237.04
|
| Rate for Payer: Cash Price |
$237.04
|
| Rate for Payer: Devoted Health Medicare |
$134.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$205.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$335.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.45
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$307.21
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: AlohaCare Medicaid |
$113.44
|
| Rate for Payer: AlohaCare Medicare |
$103.02
|
| Rate for Payer: Cash Price |
$184.33
|
| Rate for Payer: Cash Price |
$184.33
|
| Rate for Payer: Devoted Health Medicare |
$113.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$261.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.02
|
| Rate for Payer: University Health Alliance Commercial |
$129.83
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$175.32
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$149.02 |
| Rate for Payer: AlohaCare Medicaid |
$58.39
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$105.19
|
| Rate for Payer: Cash Price |
$105.19
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$149.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
| Rate for Payer: University Health Alliance Commercial |
$100.00
|
|
|
PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$974.35 |
| Max. Negotiated Rate |
$1,546.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,064.19
|
| Rate for Payer: AlohaCare Medicare |
$974.35
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Devoted Health Medicare |
$1,071.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$974.35
|
| Rate for Payer: Health Management Network Commercial |
$1,546.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,169.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,169.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,169.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,064.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$974.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,064.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$974.35
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$1,200.85
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$172.38 |
| Max. Negotiated Rate |
$1,020.72 |
| Rate for Payer: AlohaCare Medicaid |
$186.48
|
| Rate for Payer: AlohaCare Medicare |
$175.03
|
| Rate for Payer: Cash Price |
$720.51
|
| Rate for Payer: Cash Price |
$720.51
|
| Rate for Payer: Devoted Health Medicare |
$192.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$285.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$186.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$172.38
|
| Rate for Payer: Health Management Network Commercial |
$1,020.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.03
|
| Rate for Payer: University Health Alliance Commercial |
$245.26
|
|
