|
PR EXCISION THYROGLOSSAL DUCT CYST/SINUS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 60280
|
| Min. Negotiated Rate |
$386.62 |
| Max. Negotiated Rate |
$693.60 |
| Rate for Payer: AlohaCare Medicaid |
$477.90
|
| Rate for Payer: AlohaCare Medicare |
$421.14
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Devoted Health Medicare |
$463.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$421.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$386.62
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$505.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$505.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$505.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$477.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.14
|
|
|
PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 21931
|
| Min. Negotiated Rate |
$441.22 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: AlohaCare Medicaid |
$478.42
|
| Rate for Payer: AlohaCare Medicare |
$454.08
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Devoted Health Medicare |
$499.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$441.22
|
| Rate for Payer: Health Management Network Commercial |
$698.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$544.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$544.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$478.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$478.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.08
|
|
|
PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 21012
|
| Min. Negotiated Rate |
$328.64 |
| Max. Negotiated Rate |
$515.95 |
| Rate for Payer: AlohaCare Medicaid |
$353.68
|
| Rate for Payer: AlohaCare Medicare |
$331.56
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Devoted Health Medicare |
$364.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$328.64
|
| Rate for Payer: Health Management Network Commercial |
$515.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$397.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$353.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$353.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.56
|
|
|
PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM
|
Professional
|
Both
|
$745.55
|
|
|
Service Code
|
HCPCS 21011
|
| Min. Negotiated Rate |
$261.21 |
| Max. Negotiated Rate |
$633.72 |
| Rate for Payer: AlohaCare Medicaid |
$277.72
|
| Rate for Payer: AlohaCare Medicare |
$261.21
|
| Rate for Payer: Cash Price |
$447.33
|
| Rate for Payer: Cash Price |
$447.33
|
| Rate for Payer: Devoted Health Medicare |
$287.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$277.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$452.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$277.72
|
| Rate for Payer: Health Management Network Commercial |
$633.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$277.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$277.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.21
|
| Rate for Payer: University Health Alliance Commercial |
$347.45
|
|
|
PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Professional
|
Both
|
$1,002.49
|
|
|
Service Code
|
HCPCS 21930
|
| Min. Negotiated Rate |
$309.66 |
| Max. Negotiated Rate |
$852.12 |
| Rate for Payer: AlohaCare Medicaid |
$378.90
|
| Rate for Payer: AlohaCare Medicare |
$357.52
|
| Rate for Payer: Cash Price |
$601.49
|
| Rate for Payer: Cash Price |
$601.49
|
| Rate for Payer: Devoted Health Medicare |
$393.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$378.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$626.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$357.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$378.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$309.66
|
| Rate for Payer: Health Management Network Commercial |
$852.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$429.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$429.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$429.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$378.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$357.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$378.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$357.52
|
| Rate for Payer: University Health Alliance Commercial |
$471.40
|
|
|
PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM
|
Professional
|
Both
|
$717.01
|
|
|
Service Code
|
HCPCS 28043
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$609.46 |
| Rate for Payer: AlohaCare Medicaid |
$275.26
|
| Rate for Payer: AlohaCare Medicare |
$256.29
|
| Rate for Payer: Cash Price |
$430.21
|
| Rate for Payer: Cash Price |
$430.21
|
| Rate for Payer: Devoted Health Medicare |
$281.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$275.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$447.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$256.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$275.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.02
|
| Rate for Payer: Health Management Network Commercial |
$609.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$307.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$307.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$256.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$256.29
|
| Rate for Payer: University Health Alliance Commercial |
$416.00
|
|
|
PR EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 27632
|
| Min. Negotiated Rate |
$397.89 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: AlohaCare Medicaid |
$420.50
|
| Rate for Payer: AlohaCare Medicare |
$397.89
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Devoted Health Medicare |
$437.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$397.89
|
| Rate for Payer: Health Management Network Commercial |
$615.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$477.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$477.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$420.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$397.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$420.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$397.89
|
|
|
PR EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 27043
|
| Min. Negotiated Rate |
$440.44 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.84
|
| Rate for Payer: AlohaCare Medicare |
$454.65
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Devoted Health Medicare |
$500.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$440.44
|
| Rate for Payer: Health Management Network Commercial |
$697.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$545.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$545.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$545.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$477.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.65
|
|
|
PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 23071
|
| Min. Negotiated Rate |
$393.64 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: AlohaCare Medicaid |
$431.71
|
| Rate for Payer: AlohaCare Medicare |
$411.05
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Devoted Health Medicare |
$452.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$411.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.64
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$493.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$493.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$493.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$431.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$411.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$431.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$411.05
|
|
|
PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM
|
Professional
|
Both
|
$1,041.37
|
|
|
Service Code
|
HCPCS 23075
|
| Min. Negotiated Rate |
$135.46 |
| Max. Negotiated Rate |
$885.16 |
| Rate for Payer: AlohaCare Medicaid |
$345.31
|
| Rate for Payer: AlohaCare Medicare |
$329.43
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Devoted Health Medicare |
$362.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$345.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$333.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$329.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$345.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.46
|
| Rate for Payer: Health Management Network Commercial |
$885.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$395.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$329.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$345.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$329.43
|
| Rate for Payer: University Health Alliance Commercial |
$449.68
|
|
|
PR EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM
|
Professional
|
Both
|
$1,014.70
|
|
|
Service Code
|
HCPCS 27327
|
| Min. Negotiated Rate |
$317.41 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: AlohaCare Medicaid |
$331.27
|
| Rate for Payer: AlohaCare Medicare |
$317.41
|
| Rate for Payer: Cash Price |
$608.82
|
| Rate for Payer: Cash Price |
$608.82
|
| Rate for Payer: Devoted Health Medicare |
$349.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$331.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$546.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$331.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$483.60
|
| Rate for Payer: Health Management Network Commercial |
$862.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$380.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$380.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.41
|
|
|
PR EXCISION VAGINAL SEPTUM
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 57130
|
| Min. Negotiated Rate |
$156.26 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: AlohaCare Medicaid |
$180.19
|
| Rate for Payer: AlohaCare Medicare |
$156.26
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Devoted Health Medicare |
$171.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$301.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$180.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.50
|
| Rate for Payer: Health Management Network Commercial |
$351.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.26
|
| Rate for Payer: University Health Alliance Commercial |
$237.11
|
|
|
PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 27337
|
| Min. Negotiated Rate |
$411.81 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: AlohaCare Medicaid |
$430.95
|
| Rate for Payer: AlohaCare Medicare |
$411.81
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Devoted Health Medicare |
$452.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$411.81
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$494.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$494.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$430.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$411.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$430.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$411.81
|
|
|
PR EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$531.05
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$451.39 |
| Rate for Payer: AlohaCare Medicaid |
$164.92
|
| Rate for Payer: AlohaCare Medicare |
$140.16
|
| Rate for Payer: Cash Price |
$318.63
|
| Rate for Payer: Cash Price |
$318.63
|
| Rate for Payer: Devoted Health Medicare |
$154.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$164.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$270.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$164.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.00
|
| Rate for Payer: Health Management Network Commercial |
$451.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$168.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.16
|
| Rate for Payer: University Health Alliance Commercial |
$213.16
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$719.14
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$199.94 |
| Max. Negotiated Rate |
$611.27 |
| Rate for Payer: AlohaCare Medicaid |
$300.58
|
| Rate for Payer: AlohaCare Medicare |
$276.88
|
| Rate for Payer: Cash Price |
$431.48
|
| Rate for Payer: Cash Price |
$431.48
|
| Rate for Payer: Devoted Health Medicare |
$304.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$300.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$498.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$276.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$300.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.94
|
| Rate for Payer: Health Management Network Commercial |
$611.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$332.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$276.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$300.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$276.88
|
| Rate for Payer: University Health Alliance Commercial |
$392.28
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$531.63
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$154.44 |
| Max. Negotiated Rate |
$451.89 |
| Rate for Payer: AlohaCare Medicaid |
$192.75
|
| Rate for Payer: AlohaCare Medicare |
$175.43
|
| Rate for Payer: Cash Price |
$318.98
|
| Rate for Payer: Cash Price |
$318.98
|
| Rate for Payer: Devoted Health Medicare |
$192.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$192.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$324.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$192.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.44
|
| Rate for Payer: Health Management Network Commercial |
$451.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$192.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.43
|
| Rate for Payer: University Health Alliance Commercial |
$239.53
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$414.26
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$352.12 |
| Rate for Payer: AlohaCare Medicaid |
$143.17
|
| Rate for Payer: AlohaCare Medicare |
$127.72
|
| Rate for Payer: Cash Price |
$248.56
|
| Rate for Payer: Cash Price |
$248.56
|
| Rate for Payer: Devoted Health Medicare |
$140.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$143.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$234.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$143.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$352.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.72
|
| Rate for Payer: University Health Alliance Commercial |
$185.03
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$494.76
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$129.74 |
| Max. Negotiated Rate |
$420.55 |
| Rate for Payer: AlohaCare Medicaid |
$169.37
|
| Rate for Payer: AlohaCare Medicare |
$155.87
|
| Rate for Payer: Cash Price |
$296.86
|
| Rate for Payer: Cash Price |
$296.86
|
| Rate for Payer: Devoted Health Medicare |
$171.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$285.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$129.74
|
| Rate for Payer: Health Management Network Commercial |
$420.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.87
|
| Rate for Payer: University Health Alliance Commercial |
$225.13
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,259.86
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$1,070.88 |
| Rate for Payer: AlohaCare Medicaid |
$341.51
|
| Rate for Payer: AlohaCare Medicare |
$322.68
|
| Rate for Payer: Cash Price |
$755.92
|
| Rate for Payer: Cash Price |
$755.92
|
| Rate for Payer: Devoted Health Medicare |
$354.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$341.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$556.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$322.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$341.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$1,070.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$387.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$341.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$341.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.68
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$883.21
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$305.69 |
| Max. Negotiated Rate |
$750.73 |
| Rate for Payer: AlohaCare Medicaid |
$326.23
|
| Rate for Payer: AlohaCare Medicare |
$305.69
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Devoted Health Medicare |
$336.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$326.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$529.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$305.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$326.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.18
|
| Rate for Payer: Health Management Network Commercial |
$750.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$366.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.69
|
| Rate for Payer: University Health Alliance Commercial |
$406.36
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$647.38
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$550.27 |
| Rate for Payer: AlohaCare Medicaid |
$259.27
|
| Rate for Payer: AlohaCare Medicare |
$237.01
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Devoted Health Medicare |
$260.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$259.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$428.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$259.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.62
|
| Rate for Payer: Health Management Network Commercial |
$550.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$284.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$284.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$259.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.01
|
| Rate for Payer: University Health Alliance Commercial |
$337.15
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$692.65
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$196.04 |
| Max. Negotiated Rate |
$588.75 |
| Rate for Payer: AlohaCare Medicaid |
$280.11
|
| Rate for Payer: AlohaCare Medicare |
$255.67
|
| Rate for Payer: Cash Price |
$415.59
|
| Rate for Payer: Cash Price |
$415.59
|
| Rate for Payer: Devoted Health Medicare |
$281.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$280.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$466.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$280.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$196.04
|
| Rate for Payer: Health Management Network Commercial |
$588.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.67
|
| Rate for Payer: University Health Alliance Commercial |
$367.09
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$411.83
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$350.06 |
| Rate for Payer: AlohaCare Medicaid |
$130.24
|
| Rate for Payer: AlohaCare Medicare |
$116.46
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Devoted Health Medicare |
$128.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$210.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.64
|
| Rate for Payer: Health Management Network Commercial |
$350.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.46
|
| Rate for Payer: University Health Alliance Commercial |
$165.71
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR
|
Professional
|
Both
|
$569.19
|
|
|
Service Code
|
HCPCS 41826
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$483.81 |
| Rate for Payer: AlohaCare Medicaid |
$207.48
|
| Rate for Payer: AlohaCare Medicare |
$187.40
|
| Rate for Payer: Cash Price |
$341.51
|
| Rate for Payer: Cash Price |
$341.51
|
| Rate for Payer: Devoted Health Medicare |
$206.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$207.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$349.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$207.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$167.18
|
| Rate for Payer: Health Management Network Commercial |
$483.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$224.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.40
|
| Rate for Payer: University Health Alliance Commercial |
$275.35
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$413.47
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$81.38 |
| Max. Negotiated Rate |
$351.45 |
| Rate for Payer: AlohaCare Medicaid |
$131.44
|
| Rate for Payer: AlohaCare Medicare |
$121.20
|
| Rate for Payer: Cash Price |
$248.08
|
| Rate for Payer: Cash Price |
$248.08
|
| Rate for Payer: Devoted Health Medicare |
$133.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.38
|
| Rate for Payer: Health Management Network Commercial |
$351.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.20
|
| Rate for Payer: University Health Alliance Commercial |
$162.93
|
|
