|
EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 30117
|
|
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 OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,692.70
|
|
|
Service Code
|
CPT 42870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,692.70 |
| Rate for Payer: AlohaCare Medicaid |
$6,993.36
|
| Rate for Payer: AlohaCare Medicare |
$6,993.36
|
| Rate for Payer: Devoted Health Medicare |
$7,692.70
|
| 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 |
$6,993.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$6,993.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,993.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,692.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,993.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,993.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11440
|
|
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11442
|
|
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 11443
|
|
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11444
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 11446
|
|
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, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 15934
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$4,186.36
|
| Rate for Payer: AlohaCare Medicare |
$4,186.36
|
| Rate for Payer: Devoted Health Medicare |
$4,605.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,232.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,186.36
|
| Rate for Payer: Humana Medicare |
$4,186.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,186.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,605.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,186.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,186.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$5,160.40
|
|
|
Service Code
|
CPT 69145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 26111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| 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 |
$6,743.44
|
|
|
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; LESS THAN 1.5 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 26115
|
|
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 22903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| 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 |
$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 |
$6,743.44
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 22900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| 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 |
$10,679.55
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21931
|
|
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 |
$4,035.20
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21930
|
|
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, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21933
|
|
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, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21932
|
|
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, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 21013
|
|
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, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21012
|
|
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
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 25075
|
|
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, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 27632
|
|
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21552
|
|
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$5,160.40
|
|
|
Service Code
|
CPT 21555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$5,509.00
|
|
|
Service Code
|
CPT 21554
|
|
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
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$8,270.00
|
|
|
Service Code
|
CPT 21556
|
|
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
|
|
