|
PR INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA
|
Professional
|
Both
|
$447.49
|
|
|
Service Code
|
HCPCS 27093
|
| Min. Negotiated Rate |
$57.09 |
| Max. Negotiated Rate |
$380.37 |
| Rate for Payer: AlohaCare Medicaid |
$67.49
|
| Rate for Payer: AlohaCare Medicare |
$57.09
|
| Rate for Payer: Cash Price |
$268.49
|
| Rate for Payer: Cash Price |
$268.49
|
| Rate for Payer: Devoted Health Medicare |
$62.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.46
|
| Rate for Payer: Health Management Network Commercial |
$380.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.09
|
| Rate for Payer: University Health Alliance Commercial |
$93.66
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$128.38
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: AlohaCare Medicaid |
$46.10
|
| Rate for Payer: AlohaCare Medicare |
$36.52
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: Devoted Health Medicare |
$40.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$71.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.10
|
| Rate for Payer: Health Management Network Commercial |
$109.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.52
|
| Rate for Payer: University Health Alliance Commercial |
$53.12
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$107.26
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$91.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.29
|
| Rate for Payer: AlohaCare Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$64.36
|
| Rate for Payer: Cash Price |
$64.36
|
| Rate for Payer: Devoted Health Medicare |
$26.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.24
|
| Rate for Payer: Health Management Network Commercial |
$91.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.08
|
| Rate for Payer: University Health Alliance Commercial |
$32.47
|
|
|
PR INJECTION PROCEDURE LYMPHANGIOGRAPHY
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 38790
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: AlohaCare Medicaid |
$83.01
|
| Rate for Payer: AlohaCare Medicare |
$76.71
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$84.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.58
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.71
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$341.65
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: AlohaCare Medicaid |
$83.12
|
| Rate for Payer: AlohaCare Medicare |
$71.80
|
| Rate for Payer: Cash Price |
$204.99
|
| Rate for Payer: Cash Price |
$204.99
|
| Rate for Payer: Devoted Health Medicare |
$78.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$290.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.80
|
| Rate for Payer: University Health Alliance Commercial |
$111.87
|
|
|
PR INJECTION PX PEYRONIE DS W/SURG EXPOSURE PLAQUE
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$387.14 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: AlohaCare Medicaid |
$545.36
|
| Rate for Payer: AlohaCare Medicare |
$494.12
|
| Rate for Payer: Cash Price |
$560.40
|
| Rate for Payer: Cash Price |
$560.40
|
| Rate for Payer: Devoted Health Medicare |
$543.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$494.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$387.14
|
| Rate for Payer: Health Management Network Commercial |
$793.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$592.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$592.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$592.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$545.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$494.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$545.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$494.12
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$275.98
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: AlohaCare Medicaid |
$101.25
|
| Rate for Payer: AlohaCare Medicare |
$90.10
|
| Rate for Payer: Cash Price |
$165.59
|
| Rate for Payer: Cash Price |
$165.59
|
| Rate for Payer: Devoted Health Medicare |
$99.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$159.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.25
|
| Rate for Payer: Health Management Network Commercial |
$234.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.10
|
| Rate for Payer: University Health Alliance Commercial |
$134.79
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$386.91
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$63.87 |
| Max. Negotiated Rate |
$328.87 |
| Rate for Payer: AlohaCare Medicaid |
$71.98
|
| Rate for Payer: AlohaCare Medicare |
$63.87
|
| Rate for Payer: Cash Price |
$232.15
|
| Rate for Payer: Cash Price |
$232.15
|
| Rate for Payer: Devoted Health Medicare |
$70.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$139.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$328.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.87
|
| Rate for Payer: University Health Alliance Commercial |
$89.08
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$229.84
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$195.36 |
| Rate for Payer: AlohaCare Medicaid |
$36.18
|
| Rate for Payer: AlohaCare Medicare |
$32.22
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Devoted Health Medicare |
$35.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.96
|
| Rate for Payer: Health Management Network Commercial |
$195.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.22
|
| Rate for Payer: University Health Alliance Commercial |
$48.50
|
|
|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$690.69
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$587.09 |
| Rate for Payer: AlohaCare Medicaid |
$198.17
|
| Rate for Payer: AlohaCare Medicare |
$208.21
|
| Rate for Payer: Cash Price |
$414.41
|
| Rate for Payer: Cash Price |
$414.41
|
| Rate for Payer: Devoted Health Medicare |
$229.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$198.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$213.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$198.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.04
|
| Rate for Payer: Health Management Network Commercial |
$587.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$249.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$249.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.21
|
| Rate for Payer: University Health Alliance Commercial |
$263.49
|
|
|
PR INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG
|
Professional
|
Both
|
$301.58
|
|
|
Service Code
|
HCPCS 23350
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$256.34 |
| Rate for Payer: AlohaCare Medicaid |
$49.31
|
| Rate for Payer: AlohaCare Medicare |
$41.69
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Devoted Health Medicare |
$45.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$256.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.69
|
| Rate for Payer: University Health Alliance Commercial |
$72.00
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$95.60
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: AlohaCare Medicaid |
$37.23
|
| Rate for Payer: AlohaCare Medicare |
$36.40
|
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Cash Price |
$57.36
|
| Rate for Payer: Devoted Health Medicare |
$40.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$81.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.40
|
| Rate for Payer: University Health Alliance Commercial |
$45.72
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$110.51
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$93.93 |
| Rate for Payer: AlohaCare Medicaid |
$42.33
|
| Rate for Payer: AlohaCare Medicare |
$41.50
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Devoted Health Medicare |
$45.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$67.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$93.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.50
|
| Rate for Payer: University Health Alliance Commercial |
$52.01
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$111.84
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$38.50
|
| Rate for Payer: AlohaCare Medicare |
$32.77
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Devoted Health Medicare |
$36.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$95.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.77
|
| Rate for Payer: University Health Alliance Commercial |
$47.75
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$261.62
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$222.38 |
| Rate for Payer: AlohaCare Medicaid |
$35.79
|
| Rate for Payer: AlohaCare Medicare |
$30.63
|
| Rate for Payer: Cash Price |
$156.97
|
| Rate for Payer: Cash Price |
$156.97
|
| Rate for Payer: Devoted Health Medicare |
$33.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.54
|
| Rate for Payer: Health Management Network Commercial |
$222.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.63
|
| Rate for Payer: University Health Alliance Commercial |
$48.67
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$240.98
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$204.83 |
| Rate for Payer: AlohaCare Medicaid |
$93.60
|
| Rate for Payer: AlohaCare Medicare |
$86.43
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Cash Price |
$144.59
|
| Rate for Payer: Devoted Health Medicare |
$95.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$140.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.50
|
| Rate for Payer: Health Management Network Commercial |
$204.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.43
|
| Rate for Payer: University Health Alliance Commercial |
$118.66
|
|
|
PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$2,854.00
|
|
|
Service Code
|
HCPCS 36468
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$2,425.90 |
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.92
|
| Rate for Payer: Health Management Network Commercial |
$2,425.90
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$162.54
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$138.16 |
| Rate for Payer: AlohaCare Medicaid |
$57.03
|
| Rate for Payer: AlohaCare Medicare |
$48.83
|
| Rate for Payer: Cash Price |
$97.52
|
| Rate for Payer: Cash Price |
$97.52
|
| Rate for Payer: Devoted Health Medicare |
$53.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$57.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$138.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.83
|
| Rate for Payer: University Health Alliance Commercial |
$71.09
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$357.65
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: AlohaCare Medicaid |
$72.49
|
| Rate for Payer: AlohaCare Medicare |
$60.82
|
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Devoted Health Medicare |
$66.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$113.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$304.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.82
|
| Rate for Payer: University Health Alliance Commercial |
$96.05
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$333.48
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$506.22 |
| Rate for Payer: AlohaCare Medicaid |
$84.39
|
| Rate for Payer: AlohaCare Medicare |
$74.73
|
| Rate for Payer: Cash Price |
$200.09
|
| Rate for Payer: Cash Price |
$200.09
|
| Rate for Payer: Devoted Health Medicare |
$82.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$84.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$84.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$506.22
|
| Rate for Payer: Health Management Network Commercial |
$283.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.73
|
| Rate for Payer: University Health Alliance Commercial |
$125.00
|
|
|
PR INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS G0260 26
|
| Min. Negotiated Rate |
$125.13 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$125.13
|
| Rate for Payer: Health Management Network Commercial |
$320.45
|
|
|
PR INJ PERFLUTREN LIP MICROS,ML
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q9957
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: AlohaCare Medicare |
$39.96
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$43.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.96
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.96
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$156.17
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$270.92 |
| Rate for Payer: AlohaCare Medicaid |
$31.55
|
| Rate for Payer: AlohaCare Medicare |
$26.95
|
| Rate for Payer: Cash Price |
$93.70
|
| Rate for Payer: Cash Price |
$93.70
|
| Rate for Payer: Devoted Health Medicare |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.92
|
| Rate for Payer: Health Management Network Commercial |
$132.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.95
|
| Rate for Payer: University Health Alliance Commercial |
$40.00
|
|
|
PR INJ, SCULPTRA, 0.5MG
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS Q2028
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
|
|
PR INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG
|
Professional
|
Both
|
$452.64
|
|
|
Service Code
|
HCPCS 64530
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$384.74 |
| Rate for Payer: AlohaCare Medicaid |
$97.08
|
| Rate for Payer: AlohaCare Medicare |
$87.38
|
| Rate for Payer: Cash Price |
$271.58
|
| Rate for Payer: Cash Price |
$271.58
|
| Rate for Payer: Devoted Health Medicare |
$96.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$97.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$149.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$384.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$97.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.38
|
| Rate for Payer: University Health Alliance Commercial |
$120.51
|
|
