|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$487.24 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$575.60
|
| Rate for Payer: AlohaCare Medicare |
$509.41
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Devoted Health Medicare |
$560.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$509.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.24
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$611.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$611.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$611.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$575.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$509.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$575.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$509.41
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$931.44
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$791.72 |
| Rate for Payer: AlohaCare Medicaid |
$367.06
|
| Rate for Payer: AlohaCare Medicare |
$326.41
|
| Rate for Payer: Cash Price |
$558.86
|
| Rate for Payer: Cash Price |
$558.86
|
| Rate for Payer: Devoted Health Medicare |
$359.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$367.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$605.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$367.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.88
|
| Rate for Payer: Health Management Network Commercial |
$791.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$391.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.41
|
| Rate for Payer: University Health Alliance Commercial |
$476.87
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,211.21
|
| Rate for Payer: AlohaCare Medicare |
$1,123.04
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Devoted Health Medicare |
$1,235.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,123.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.64
|
| Rate for Payer: Health Management Network Commercial |
$1,762.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,347.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,347.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,347.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,211.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,123.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,211.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,123.04
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: AlohaCare Medicaid |
$963.41
|
| Rate for Payer: AlohaCare Medicare |
$897.13
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Devoted Health Medicare |
$986.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$897.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$569.40
|
| Rate for Payer: Health Management Network Commercial |
$1,398.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,076.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,076.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,076.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$963.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$963.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.13
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$636.22 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: AlohaCare Medicaid |
$779.22
|
| Rate for Payer: AlohaCare Medicare |
$733.18
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Devoted Health Medicare |
$806.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$733.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.22
|
| Rate for Payer: Health Management Network Commercial |
$1,130.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$879.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$879.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$779.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$733.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$779.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$733.18
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$320.84 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: AlohaCare Medicaid |
$428.86
|
| Rate for Payer: AlohaCare Medicare |
$401.38
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Devoted Health Medicare |
$441.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.84
|
| Rate for Payer: Health Management Network Commercial |
$623.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$428.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$428.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.38
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$306.28 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: AlohaCare Medicaid |
$424.65
|
| Rate for Payer: AlohaCare Medicare |
$383.78
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Devoted Health Medicare |
$422.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$383.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.28
|
| Rate for Payer: Health Management Network Commercial |
$615.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$460.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$460.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$460.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$424.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$383.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$383.78
|
|
|
PR EXC PENILE PLAQUE GRAFT > 5 CM LENGTH
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 54112
|
| Min. Negotiated Rate |
$771.68 |
| Max. Negotiated Rate |
$1,375.30 |
| Rate for Payer: AlohaCare Medicaid |
$944.28
|
| Rate for Payer: AlohaCare Medicare |
$843.44
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Devoted Health Medicare |
$927.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$843.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$771.68
|
| Rate for Payer: Health Management Network Commercial |
$1,375.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$944.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$843.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$944.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$843.44
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,852.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$922.93 |
| Max. Negotiated Rate |
$1,574.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.68
|
| Rate for Payer: AlohaCare Medicare |
$922.93
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Devoted Health Medicare |
$1,015.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,157.52
|
| Rate for Payer: Health Management Network Commercial |
$1,574.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.93
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: AlohaCare Medicaid |
$651.40
|
| Rate for Payer: AlohaCare Medicare |
$563.74
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Devoted Health Medicare |
$620.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$563.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network Commercial |
$944.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$676.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$676.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$676.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$651.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$563.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$651.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$563.74
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,068.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$1,026.40 |
| Max. Negotiated Rate |
$1,757.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,210.85
|
| Rate for Payer: AlohaCare Medicare |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Devoted Health Medicare |
$1,129.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,026.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,341.08
|
| Rate for Payer: Health Management Network Commercial |
$1,757.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,231.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,231.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,231.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,210.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,026.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,210.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,026.40
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ
|
Professional
|
Both
|
$2,339.00
|
|
|
Service Code
|
HCPCS 42426
|
| Min. Negotiated Rate |
$1,159.83 |
| Max. Negotiated Rate |
$1,988.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,370.43
|
| Rate for Payer: AlohaCare Medicare |
$1,159.83
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Devoted Health Medicare |
$1,275.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,159.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,311.18
|
| Rate for Payer: Health Management Network Commercial |
$1,988.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,391.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,391.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,391.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,370.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,159.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,370.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,159.83
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$669.76 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,083.88
|
| Rate for Payer: AlohaCare Medicare |
$999.41
|
| Rate for Payer: Cash Price |
$1,112.40
|
| Rate for Payer: Cash Price |
$1,112.40
|
| Rate for Payer: Devoted Health Medicare |
$1,099.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$999.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$669.76
|
| Rate for Payer: Health Management Network Commercial |
$1,575.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,199.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,199.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,199.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,083.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$999.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,083.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$999.41
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$809.46 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: AlohaCare Medicaid |
$844.38
|
| Rate for Payer: AlohaCare Medicare |
$809.46
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Devoted Health Medicare |
$890.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$809.46
|
| Rate for Payer: Health Management Network Commercial |
$1,227.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$971.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$971.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$971.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$844.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$809.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$844.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$809.46
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,103.48
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$577.46 |
| Max. Negotiated Rate |
$937.96 |
| Rate for Payer: AlohaCare Medicaid |
$640.36
|
| Rate for Payer: AlohaCare Medicare |
$630.37
|
| Rate for Payer: Cash Price |
$662.09
|
| Rate for Payer: Cash Price |
$662.09
|
| Rate for Payer: Devoted Health Medicare |
$693.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$630.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$577.46
|
| Rate for Payer: Health Management Network Commercial |
$937.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$756.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$756.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$640.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$630.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$640.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$630.37
|
|
|
PR EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY
|
Professional
|
Both
|
$1,535.00
|
|
|
Service Code
|
HCPCS 15933
|
| Min. Negotiated Rate |
$533.26 |
| Max. Negotiated Rate |
$1,304.75 |
| Rate for Payer: AlohaCare Medicaid |
$896.43
|
| Rate for Payer: AlohaCare Medicare |
$833.83
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Devoted Health Medicare |
$917.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$833.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$533.26
|
| Rate for Payer: Health Management Network Commercial |
$1,304.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,000.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,000.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,000.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$896.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$833.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$896.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$833.83
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$1,076.92
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$915.38 |
| Rate for Payer: AlohaCare Medicaid |
$368.90
|
| Rate for Payer: AlohaCare Medicare |
$335.87
|
| Rate for Payer: Cash Price |
$646.15
|
| Rate for Payer: Cash Price |
$646.15
|
| Rate for Payer: Devoted Health Medicare |
$369.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$368.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$603.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$335.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$368.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$100.36
|
| Rate for Payer: Health Management Network Commercial |
$915.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$403.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$403.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$368.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$335.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$368.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$335.87
|
| Rate for Payer: University Health Alliance Commercial |
$479.32
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$441.28
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$375.09 |
| Rate for Payer: AlohaCare Medicaid |
$117.38
|
| Rate for Payer: AlohaCare Medicare |
$110.50
|
| Rate for Payer: Cash Price |
$264.77
|
| Rate for Payer: Cash Price |
$264.77
|
| Rate for Payer: Devoted Health Medicare |
$121.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$117.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$194.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.94
|
| Rate for Payer: Health Management Network Commercial |
$375.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.50
|
| Rate for Payer: University Health Alliance Commercial |
$152.04
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,143.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$312.78 |
| Max. Negotiated Rate |
$971.55 |
| Rate for Payer: AlohaCare Medicaid |
$665.74
|
| Rate for Payer: AlohaCare Medicare |
$606.30
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Devoted Health Medicare |
$666.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$606.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.78
|
| Rate for Payer: Health Management Network Commercial |
$971.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$727.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$727.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$727.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$665.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$606.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$665.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$606.30
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$518.43 |
| Max. Negotiated Rate |
$820.25 |
| Rate for Payer: AlohaCare Medicaid |
$560.44
|
| Rate for Payer: AlohaCare Medicare |
$518.43
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Devoted Health Medicare |
$570.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.43
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$622.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$622.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$560.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$560.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.43
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$431.08 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: AlohaCare Medicaid |
$456.89
|
| Rate for Payer: AlohaCare Medicare |
$431.08
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Devoted Health Medicare |
$474.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$431.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$432.12
|
| Rate for Payer: Health Management Network Commercial |
$666.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$517.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$517.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$517.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$456.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$431.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$431.08
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,279.00
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$546.52 |
| Max. Negotiated Rate |
$1,087.15 |
| Rate for Payer: AlohaCare Medicaid |
$746.05
|
| Rate for Payer: AlohaCare Medicare |
$697.14
|
| Rate for Payer: Cash Price |
$767.40
|
| Rate for Payer: Cash Price |
$767.40
|
| Rate for Payer: Devoted Health Medicare |
$766.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$697.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$546.52
|
| Rate for Payer: Health Management Network Commercial |
$1,087.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$836.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$836.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$746.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$697.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$746.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$697.14
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$627.48 |
| Max. Negotiated Rate |
$986.85 |
| Rate for Payer: AlohaCare Medicaid |
$674.32
|
| Rate for Payer: AlohaCare Medicare |
$627.48
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Devoted Health Medicare |
$690.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$627.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$646.88
|
| Rate for Payer: Health Management Network Commercial |
$986.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$752.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$674.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$674.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.48
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$489.70 |
| Max. Negotiated Rate |
$789.65 |
| Rate for Payer: AlohaCare Medicaid |
$541.76
|
| Rate for Payer: AlohaCare Medicare |
$489.70
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Devoted Health Medicare |
$538.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$489.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.74
|
| Rate for Payer: Health Management Network Commercial |
$789.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$587.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$587.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$587.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$541.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$489.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$541.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$489.70
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM
|
Professional
|
Both
|
$1,050.91
|
|
|
Service Code
|
HCPCS 21013
|
| Min. Negotiated Rate |
$380.26 |
| Max. Negotiated Rate |
$893.27 |
| Rate for Payer: AlohaCare Medicaid |
$419.80
|
| Rate for Payer: AlohaCare Medicare |
$380.26
|
| Rate for Payer: Cash Price |
$630.55
|
| Rate for Payer: Cash Price |
$630.55
|
| Rate for Payer: Devoted Health Medicare |
$418.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$419.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$693.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$380.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$419.80
|
| Rate for Payer: Health Management Network Commercial |
$893.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$456.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$456.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$456.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$419.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$380.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$419.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$380.26
|
|
