|
55150 Resection of scrotum
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
8039820
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$506.09
|
| Rate for Payer: AlohaCare Medicare |
$461.54
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$507.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$365.04
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$461.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$661.24
|
|
|
55175 Scrotoplasty; simple
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55175
|
| Hospital Charge Code |
8039821
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$377.12
|
| Rate for Payer: AlohaCare Medicare |
$346.07
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$380.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.58
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$346.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
8039822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$1,020.85 |
| Rate for Payer: AlohaCare Medicaid |
$240.51
|
| Rate for Payer: AlohaCare Medicare |
$225.11
|
| Rate for Payer: Cash Price |
$780.65
|
| Rate for Payer: Cash Price |
$780.65
|
| Rate for Payer: Devoted Health Medicare |
$247.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$240.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$240.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$1,020.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$270.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$270.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.11
|
| Rate for Payer: University Health Alliance Commercial |
$510.87
|
|
|
55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
8039822
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$240.51
|
| Rate for Payer: AlohaCare Medicare |
$225.11
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Devoted Health Medicare |
$247.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$364.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$510.87
|
|
|
55400 Vasovasostomy, vasovasorrhaphy
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55400
|
| Hospital Charge Code |
8039823
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$510.45
|
| Rate for Payer: AlohaCare Medicare |
$460.62
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$506.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$435.24
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$552.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$510.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$460.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
|
|
55500 Excision of hydrocele of spermatic cord, unilateral (separate procedure)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55500
|
| Hospital Charge Code |
8039824
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$402.84
|
| Rate for Payer: AlohaCare Medicare |
$373.06
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$410.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$376.22
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$447.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55520 Excision of lesion of spermatic cord (separate procedure)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
8039825
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$466.13
|
| Rate for Payer: AlohaCare Medicare |
$450.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$495.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.58
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$466.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$450.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55530 Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
8039826
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$363.00
|
| Rate for Payer: AlohaCare Medicare |
$332.14
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$365.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$410.80
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55559 LAPARO PROC, SPERMATIC CORD
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
9902266
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
|
|
55559 UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD ProFee
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
8020901
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$7,151.90 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
|
|
55700 Biopsy, prostate; needle or punch, single or multiple, any approach
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
8039827
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$587.35 |
| Rate for Payer: AlohaCare Medicaid |
$129.17
|
| Rate for Payer: Cash Price |
$449.15
|
| Rate for Payer: Cash Price |
$449.15
|
| Rate for Payer: Cash Price |
$449.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$207.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$587.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$349.00
|
|
|
55720 Prostatotomy, external drainage of prostatic abscess, any approach; simple
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 55720
|
| Hospital Charge Code |
8039828
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$462.46
|
| Rate for Payer: AlohaCare Medicare |
$419.28
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$461.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$329.68
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$419.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55821 Prostatectomy, suprapubic, subtotal, 1 or 2 stages
|
Professional
|
Both
|
$2,392.00
|
|
|
Service Code
|
HCPCS 55821
|
| Hospital Charge Code |
8039829
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: AlohaCare Medicaid |
$845.45
|
| Rate for Payer: AlohaCare Medicare |
$755.33
|
| Rate for Payer: Cash Price |
$1,554.80
|
| Rate for Payer: Cash Price |
$1,554.80
|
| Rate for Payer: Cash Price |
$1,554.80
|
| Rate for Payer: Devoted Health Medicare |
$830.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$785.98
|
| Rate for Payer: Health Management Network Commercial |
$2,033.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$906.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$845.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$755.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55840 Prostatectomy, retropubic radical, with or without nerve sparing;
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 55840
|
| Hospital Charge Code |
8039830
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,720.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,174.34
|
| Rate for Payer: AlohaCare Medicare |
$1,042.28
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Devoted Health Medicare |
$1,146.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$936.00
|
| Rate for Payer: Health Management Network Commercial |
$2,720.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,250.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,174.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,042.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55842 Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s)
|
Professional
|
Both
|
$3,199.00
|
|
|
Service Code
|
HCPCS 55842
|
| Hospital Charge Code |
8039831
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,719.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,173.77
|
| Rate for Payer: AlohaCare Medicare |
$1,040.37
|
| Rate for Payer: Cash Price |
$2,079.35
|
| Rate for Payer: Cash Price |
$2,079.35
|
| Rate for Payer: Cash Price |
$2,079.35
|
| Rate for Payer: Devoted Health Medicare |
$1,144.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,613.04
|
| Rate for Payer: Health Management Network Commercial |
$2,719.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,248.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,173.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,040.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55845 Prostatectomy, retropubic radical, with or without nerve sparing; with lymphadenectomy
|
Professional
|
Both
|
$3,662.00
|
|
|
Service Code
|
HCPCS 55845
|
| Hospital Charge Code |
8039832
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,112.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,361.91
|
| Rate for Payer: AlohaCare Medicare |
$1,203.72
|
| Rate for Payer: Cash Price |
$2,380.30
|
| Rate for Payer: Cash Price |
$2,380.30
|
| Rate for Payer: Cash Price |
$2,380.30
|
| Rate for Payer: Devoted Health Medicare |
$1,324.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,973.92
|
| Rate for Payer: Health Management Network Commercial |
$3,112.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,444.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,361.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,203.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55866 Laparaoscopy, surgical prostatectomy, retro radical,includes nerve sparing/robot assist
|
Professional
|
Both
|
$14,794.00
|
|
|
Service Code
|
HCPCS 55866
|
| Hospital Charge Code |
8039833
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$12,574.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,193.90
|
| Rate for Payer: AlohaCare Medicare |
$1,077.11
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Cash Price |
$9,616.10
|
| Rate for Payer: Devoted Health Medicare |
$1,184.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,571.18
|
| Rate for Payer: Health Management Network Commercial |
$12,574.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,292.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,193.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,077.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
55873 Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)
|
Professional
|
Both
|
$15,422.00
|
|
|
Service Code
|
HCPCS 55873
|
| Hospital Charge Code |
8039834
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$13,108.70 |
| Rate for Payer: AlohaCare Medicaid |
$773.82
|
| Rate for Payer: AlohaCare Medicare |
$690.53
|
| Rate for Payer: Cash Price |
$10,024.30
|
| Rate for Payer: Cash Price |
$10,024.30
|
| Rate for Payer: Cash Price |
$10,024.30
|
| Rate for Payer: Devoted Health Medicare |
$759.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,699.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$13,108.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$828.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$773.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$690.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$1,010.42
|
|
|
55876 Placement of interstitial device(s) for radiation therapy guidance, prostate, single/multiple
|
Professional
|
Both
|
$1,926.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
8039835
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$1,637.10 |
| Rate for Payer: AlohaCare Medicaid |
$104.35
|
| Rate for Payer: AlohaCare Medicare |
$92.02
|
| Rate for Payer: Cash Price |
$1,251.90
|
| Rate for Payer: Cash Price |
$1,251.90
|
| Rate for Payer: Cash Price |
$1,251.90
|
| Rate for Payer: Devoted Health Medicare |
$101.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$159.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$1,637.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
5.5MM ELITE ACROMIOBLASTER BURR
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
8336061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
|
|
5.5MM ELITE ACROMIOBLASTER BURR
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
8336061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$134.00
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Devoted Health Medicare |
$147.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$134.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.00
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.00
|
| Rate for Payer: University Health Alliance Commercial |
$195.35
|
|
|
56405-I&D Vulva/Perineal Abscess
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8080062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$553.00
|
| Rate for Payer: AlohaCare Medicare |
$553.00
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: Devoted Health Medicare |
$608.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$553.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,050.70
|
| Rate for Payer: Health Management Network Commercial |
$940.10
|
| Rate for Payer: Humana Medicare |
$553.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$995.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$553.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,072.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$553.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$553.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$553.00
|
| Rate for Payer: University Health Alliance Commercial |
$806.16
|
|
|
56405-I&D Vulva/Perineal Abscess
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8080062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$940.10 |
| Max. Negotiated Rate |
$1,072.82 |
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: Health Management Network Commercial |
$940.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$995.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,072.82
|
|
|
56405 I&D VULVA/PERINEAL ABSCESS TechFee
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8211339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,058.25 |
| Max. Negotiated Rate |
$1,207.65 |
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,120.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
|
|
56405 I&D VULVA/PERINEAL ABSCESS TechFee
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
8211339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$622.50
|
| Rate for Payer: AlohaCare Medicare |
$622.50
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Devoted Health Medicare |
$684.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,182.75
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Humana Medicare |
$622.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,120.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.50
|
| Rate for Payer: University Health Alliance Commercial |
$907.48
|
|
