|
G0102 Prostate cancer screening; digital rectal examination
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS G0102
|
| Hospital Charge Code |
8040932
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$8.86
|
| Rate for Payer: AlohaCare Medicare |
$7.72
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$8.49
|
| 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 |
$21.62
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.26
|
| 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 |
$8.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.72
|
| 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 |
$8.61
|
|
|
G0103 Prostate cancer screening; prostate specific antigen test
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
8040933
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: AlohaCare Medicaid |
$25.42
|
| Rate for Payer: AlohaCare Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$21.24
|
| 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 |
$45.10
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.17
|
| 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 |
$25.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.31
|
| 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
|
|
|
G0104 Colorectal cancer screening; flexible sigmoidoscopy
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
8040934
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$54.96
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Devoted Health Medicare |
$60.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.21
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.96
|
|
|
G0104 Colorectal cancer screening; flexible sigmoidoscopy
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
8040934
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$54.96
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Devoted Health Medicare |
$60.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$88.83
|
| 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 |
$106.21
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.95
|
| 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 |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.96
|
| 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
|
|
|
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
8040935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.06
|
| Rate for Payer: AlohaCare Medicare |
$165.03
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.46
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.03
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
8040935
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.06
|
| Rate for Payer: AlohaCare Medicare |
$165.03
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.60
|
| 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 Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.46
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 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 |
$184.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
8040938
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.24
|
| Rate for Payer: AlohaCare Medicare |
$165.23
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| 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 |
$237.64
|
| 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 |
$319.54
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 Medicaid |
$434.26
|
| 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 |
$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 |
$184.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
8040938
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$1,002.15 |
| Rate for Payer: AlohaCare Medicaid |
$184.24
|
| Rate for Payer: AlohaCare Medicare |
$165.23
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Devoted Health Medicare |
$181.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.54
|
| Rate for Payer: Health Management Network Commercial |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.23
|
| Rate for Payer: University Health Alliance Commercial |
$125.26
|
|
|
G0124 Screening cytopathology, cervical or vaginal, thin layer preparation, interp by physician
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
8040939
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$26.05
|
| Rate for Payer: AlohaCare Medicare |
$26.01
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$28.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| 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 |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.21
|
| 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 |
$26.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.01
|
| 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
|
|
|
G0127 Trimming of dystrophic nails, any number
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
8040940
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$7.38
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$7.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.64
|
| 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 |
$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 |
$27.60
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.96
|
| 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 |
$7.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| 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
|
|
|
G0127 Trimming of dystrophic nails, any number
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
8040940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: AlohaCare Medicaid |
$7.38
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$7.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.63
|
|
|
G0136 Social Determinates of Health Risk Assessment
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
12245700
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| 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 |
$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 |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| 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 |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| 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 |
$8.98
|
|
|
G0168 Wound closure utilizing tissue adhesive(s) only
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
8040941
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$14.12
|
| Rate for Payer: AlohaCare Medicare |
$13.27
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Devoted Health Medicare |
$14.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.80
|
| 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 Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.75
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| 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 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 |
$14.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$13.54
|
|
|
G0245 Initial eval/management of diabetic patient
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
8041157
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$39.98
|
| Rate for Payer: AlohaCare Medicare |
$34.82
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Devoted Health Medicare |
$38.30
|
| 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 |
$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 |
$170.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.78
|
| 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 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 |
$39.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$38.48
|
|
|
G0268 Removal of impacted cerumen, same date of service as audiologic function testing
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
8040945
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$33.08
|
| Rate for Payer: AlohaCare Medicare |
$26.95
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Devoted Health Medicare |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.80
|
| 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 |
$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 |
$38.48
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.34
|
| 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 |
$33.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.95
|
| 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 |
$31.96
|
|
|
G0281 Electrical stimulation, one or more areas, unattended wound care
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
8040948
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$12.28
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Devoted Health Medicare |
$13.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$246.64
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.74
|
| 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 |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.28
|
| 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 |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
G0283 Electrical stimulation, one or more areas, other than wound care, part of therapy plan of care
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
8040949
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Devoted Health Medicare |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.52
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.42
|
|
|
G0283 Electrical stimulation, one or more areas, other than wound care, part of therapy plan of care
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
8040949
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Devoted Health Medicare |
$14.76
|
| 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 |
$13.52
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.10
|
| 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 |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.42
|
| 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
|
|
|
G0283 ESTIM UNATTENDED PT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS G0283 GP,59
|
| Hospital Charge Code |
8323308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
G0283 ESTIM UNATTENDED PT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS G0283 GP,59
|
| Hospital Charge Code |
8323308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$34.50
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Devoted Health Medicare |
$37.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.55
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$34.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.50
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.50
|
| Rate for Payer: University Health Alliance Commercial |
$38.64
|
|
|
G0283 UNATTENDED ESTIM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS G0283 GP,CQ
|
| Hospital Charge Code |
8323309
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
G0283 UNATTENDED ESTIM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS G0283 GP,CQ
|
| Hospital Charge Code |
8323309
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$34.50
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Devoted Health Medicare |
$37.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.55
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$34.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.50
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.50
|
| Rate for Payer: University Health Alliance Commercial |
$38.64
|
|
|
G0289 Arthroscopy, knee, surgical, for removal of loose/foreign body
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
8040950
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$83.94
|
| Rate for Payer: AlohaCare Medicare |
$70.80
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$77.88
|
| 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 |
$97.62
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| 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 Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| 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: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.80
|
| 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 |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
G0316 PROLONG HSP INPT, OBSV E&M BEYOND TOTAL TIME OF PRIM SVC, ADD'L 15 MIN, W/WO PAT CONTACT
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS G0316
|
| Hospital Charge Code |
10602926
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$289.59 |
| Rate for Payer: AlohaCare Medicaid |
$30.61
|
| Rate for Payer: AlohaCare Medicare |
$27.80
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Devoted Health Medicare |
$30.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.59
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.80
|
| Rate for Payer: University Health Alliance Commercial |
$30.12
|
|
|
G0317 PROLONG NF E&M SVC BEYOND TOTAL TIME OF PRIM SVC, ADD'L 15 MIN, W/WO PAT CONTACT
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS G0317
|
| Hospital Charge Code |
10602927
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$315.26 |
| Rate for Payer: AlohaCare Medicaid |
$30.61
|
| Rate for Payer: AlohaCare Medicare |
$27.22
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$29.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$315.26
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.22
|
| Rate for Payer: University Health Alliance Commercial |
$29.75
|
|
