|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,438.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 15830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$13,778.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,844.33
|
| Rate for Payer: AlohaCare Medicare |
$7,844.33
|
| Rate for Payer: Devoted Health Medicare |
$8,628.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,844.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Humana Medicare |
$7,844.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,844.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,628.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,844.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,844.33
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 15832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
|
Facility
|
OP
|
$4,289.34
|
|
|
Service Code
|
CPT 69110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,289.34 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,289.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,431.47
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 30130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$3,916.70
|
| Rate for Payer: AlohaCare Medicare |
$3,916.70
|
| Rate for Payer: Devoted Health Medicare |
$4,308.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,916.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$3,916.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,916.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,308.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,916.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,916.70
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
|
Facility
|
OP
|
$8,270.00
|
|
|
Service Code
|
CPT 42104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,270.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,916.70
|
| Rate for Payer: AlohaCare Medicare |
$3,916.70
|
| Rate for Payer: Devoted Health Medicare |
$4,308.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,916.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$3,916.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,916.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,308.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,916.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,916.70
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,438.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$8,270.00
|
|
|
Service Code
|
CPT 11646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,270.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,045.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11604
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, NASAL POLYP(S), SIMPLE
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 30110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,832.96
|
| Rate for Payer: AlohaCare Medicare |
$1,832.96
|
| Rate for Payer: Devoted Health Medicare |
$2,016.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,291.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,832.96
|
| Rate for Payer: Humana Medicare |
$1,832.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,832.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,016.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,832.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,832.96
|
|
|
EXCISION OF BARTHOLIN'S GLAND OR CYST
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 56740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$3,824.16
|
| Rate for Payer: AlohaCare Medicare |
$3,824.16
|
| Rate for Payer: Devoted Health Medicare |
$4,206.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,824.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$3,824.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,824.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,206.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,824.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,824.16
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; SINGLE LESION
|
Facility
|
OP
|
$8,270.00
|
|
|
Service Code
|
CPT 19125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,270.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,625.48
|
| Rate for Payer: AlohaCare Medicare |
$4,625.48
|
| Rate for Payer: Devoted Health Medicare |
$5,088.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,625.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$4,625.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,625.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,088.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,625.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,625.48
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
