|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: AlohaCare Medicaid |
$86.46
|
| Rate for Payer: AlohaCare Medicare |
$76.74
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$84.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.72
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.74
|
|
|
PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP
|
Professional
|
Both
|
$39.22
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: AlohaCare Medicaid |
$20.26
|
| Rate for Payer: AlohaCare Medicare |
$22.41
|
| Rate for Payer: Cash Price |
$23.53
|
| Rate for Payer: Cash Price |
$23.53
|
| Rate for Payer: Devoted Health Medicare |
$24.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.25
|
| Rate for Payer: Health Management Network Commercial |
$33.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.41
|
|
|
PR DERMABRASION SEGMENTAL FACE
|
Professional
|
Both
|
$976.69
|
|
|
Service Code
|
HCPCS 15781
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$830.19 |
| Rate for Payer: AlohaCare Medicaid |
$451.51
|
| Rate for Payer: AlohaCare Medicare |
$385.70
|
| Rate for Payer: Cash Price |
$586.01
|
| Rate for Payer: Cash Price |
$586.01
|
| Rate for Payer: Devoted Health Medicare |
$424.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$451.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$747.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$451.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.18
|
| Rate for Payer: Health Management Network Commercial |
$830.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$462.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$462.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$462.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$451.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.70
|
| Rate for Payer: University Health Alliance Commercial |
$514.24
|
|
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$248.31
|
|
|
Service Code
|
HCPCS 17111
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$211.06 |
| Rate for Payer: AlohaCare Medicaid |
$89.23
|
| Rate for Payer: AlohaCare Medicare |
$78.09
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Devoted Health Medicare |
$85.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$89.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.66
|
| Rate for Payer: Health Management Network Commercial |
$211.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.09
|
| Rate for Payer: University Health Alliance Commercial |
$97.90
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$212.92
|
|
|
Service Code
|
HCPCS 17110
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$180.98 |
| Rate for Payer: AlohaCare Medicaid |
$74.33
|
| Rate for Payer: AlohaCare Medicare |
$66.60
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Cash Price |
$127.75
|
| Rate for Payer: Devoted Health Medicare |
$73.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$74.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.20
|
| Rate for Payer: Health Management Network Commercial |
$180.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.60
|
| Rate for Payer: University Health Alliance Commercial |
$81.21
|
|
|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$502.98
|
|
|
Service Code
|
HCPCS 56515
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$427.53 |
| Rate for Payer: AlohaCare Medicaid |
$220.87
|
| Rate for Payer: AlohaCare Medicare |
$192.86
|
| Rate for Payer: Cash Price |
$301.79
|
| Rate for Payer: Cash Price |
$301.79
|
| Rate for Payer: Devoted Health Medicare |
$212.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$220.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$368.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$220.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.32
|
| Rate for Payer: Health Management Network Commercial |
$427.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$231.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$231.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$220.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.86
|
| Rate for Payer: University Health Alliance Commercial |
$360.00
|
|
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 56501
|
| Min. Negotiated Rate |
$93.34 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: AlohaCare Medicaid |
$142.37
|
| Rate for Payer: AlohaCare Medicare |
$124.63
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Devoted Health Medicare |
$137.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.34
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.63
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$261.70
|
|
|
Service Code
|
HCPCS 17280
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: AlohaCare Medicaid |
$91.23
|
| Rate for Payer: AlohaCare Medicare |
$77.01
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Devoted Health Medicare |
$84.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$147.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.94
|
| Rate for Payer: Health Management Network Commercial |
$222.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.01
|
| Rate for Payer: University Health Alliance Commercial |
$101.55
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$277.44
|
|
|
Service Code
|
HCPCS 17270
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$235.82 |
| Rate for Payer: AlohaCare Medicaid |
$100.04
|
| Rate for Payer: AlohaCare Medicare |
$83.73
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Devoted Health Medicare |
$92.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$100.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$161.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$100.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.48
|
| Rate for Payer: Health Management Network Commercial |
$235.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.73
|
| Rate for Payer: University Health Alliance Commercial |
$111.14
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 17271
|
| Min. Negotiated Rate |
$91.74 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: AlohaCare Medicaid |
$109.71
|
| Rate for Payer: AlohaCare Medicare |
$91.74
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Devoted Health Medicare |
$100.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$109.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.54
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.74
|
| Rate for Payer: University Health Alliance Commercial |
$122.66
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 17272
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: AlohaCare Medicaid |
$126.09
|
| Rate for Payer: AlohaCare Medicare |
$104.00
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$114.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$126.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$126.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.00
|
| Rate for Payer: University Health Alliance Commercial |
$141.84
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$383.13
|
|
|
Service Code
|
HCPCS 17273
|
| Min. Negotiated Rate |
$117.15 |
| Max. Negotiated Rate |
$325.66 |
| Rate for Payer: AlohaCare Medicaid |
$142.09
|
| Rate for Payer: AlohaCare Medicare |
$117.15
|
| Rate for Payer: Cash Price |
$229.88
|
| Rate for Payer: Cash Price |
$229.88
|
| Rate for Payer: Devoted Health Medicare |
$128.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$232.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.50
|
| Rate for Payer: Health Management Network Commercial |
$325.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.15
|
| Rate for Payer: University Health Alliance Commercial |
$160.24
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$447.11
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$141.56 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: AlohaCare Medicaid |
$172.86
|
| Rate for Payer: AlohaCare Medicare |
$141.56
|
| Rate for Payer: Cash Price |
$268.27
|
| Rate for Payer: Cash Price |
$268.27
|
| Rate for Payer: Devoted Health Medicare |
$155.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$283.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.66
|
| Rate for Payer: Health Management Network Commercial |
$380.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.56
|
| Rate for Payer: University Health Alliance Commercial |
$195.40
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: AlohaCare Medicaid |
$74.37
|
| Rate for Payer: AlohaCare Medicare |
$61.43
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$67.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$74.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.43
|
| Rate for Payer: University Health Alliance Commercial |
$83.93
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$102.09 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: AlohaCare Medicaid |
$122.90
|
| Rate for Payer: AlohaCare Medicare |
$102.09
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Devoted Health Medicare |
$112.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$145.08
|
| Rate for Payer: Health Management Network Commercial |
$281.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.09
|
| Rate for Payer: University Health Alliance Commercial |
$138.32
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$116.44 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: AlohaCare Medicaid |
$141.38
|
| Rate for Payer: AlohaCare Medicare |
$116.44
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Devoted Health Medicare |
$128.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.20
|
| Rate for Payer: Health Management Network Commercial |
$320.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.44
|
| Rate for Payer: University Health Alliance Commercial |
$159.42
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: AlohaCare Medicaid |
$176.04
|
| Rate for Payer: AlohaCare Medicare |
$143.61
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$157.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$287.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$176.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.61
|
| Rate for Payer: University Health Alliance Commercial |
$198.22
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$505.22
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$167.56 |
| Max. Negotiated Rate |
$429.44 |
| Rate for Payer: AlohaCare Medicaid |
$204.28
|
| Rate for Payer: AlohaCare Medicare |
$167.56
|
| Rate for Payer: Cash Price |
$303.13
|
| Rate for Payer: Cash Price |
$303.13
|
| Rate for Payer: Devoted Health Medicare |
$184.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$204.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$336.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$167.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$204.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$429.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$167.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$167.56
|
| Rate for Payer: University Health Alliance Commercial |
$231.68
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: AlohaCare Medicaid |
$91.61
|
| Rate for Payer: AlohaCare Medicare |
$77.01
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Devoted Health Medicare |
$84.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$148.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.32
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.01
|
| Rate for Payer: University Health Alliance Commercial |
$102.00
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: AlohaCare Medicaid |
$115.19
|
| Rate for Payer: AlohaCare Medicare |
$95.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Devoted Health Medicare |
$105.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$115.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$187.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$115.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.52
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.70
|
| Rate for Payer: University Health Alliance Commercial |
$129.12
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$302.60 |
| Rate for Payer: AlohaCare Medicaid |
$127.14
|
| Rate for Payer: AlohaCare Medicare |
$105.04
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$115.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$207.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$127.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.04
|
| Rate for Payer: University Health Alliance Commercial |
$143.05
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$380.34
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$323.29 |
| Rate for Payer: AlohaCare Medicaid |
$135.57
|
| Rate for Payer: AlohaCare Medicare |
$111.77
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Devoted Health Medicare |
$122.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$135.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$221.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$135.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$130.78
|
| Rate for Payer: Health Management Network Commercial |
$323.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$135.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.77
|
| Rate for Payer: University Health Alliance Commercial |
$152.64
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$792.07
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$136.26 |
| Max. Negotiated Rate |
$673.26 |
| Rate for Payer: AlohaCare Medicaid |
$149.86
|
| Rate for Payer: AlohaCare Medicare |
$136.26
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Cash Price |
$475.24
|
| Rate for Payer: Devoted Health Medicare |
$149.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$149.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$149.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$460.98
|
| Rate for Payer: Health Management Network Commercial |
$673.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$149.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.26
|
| Rate for Payer: University Health Alliance Commercial |
$195.96
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$308.02
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: AlohaCare Medicaid |
$103.10
|
| Rate for Payer: AlohaCare Medicare |
$85.63
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Cash Price |
$184.81
|
| Rate for Payer: Devoted Health Medicare |
$94.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$202.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$178.88
|
| Rate for Payer: Health Management Network Commercial |
$261.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.63
|
| Rate for Payer: University Health Alliance Commercial |
$115.54
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: AlohaCare Medicaid |
$59.29
|
| Rate for Payer: AlohaCare Medicare |
$50.49
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$55.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$96.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.12
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.49
|
| Rate for Payer: University Health Alliance Commercial |
$66.31
|
|
