|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$251.02
|
|
|
Service Code
|
HCPCS 11311
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: AlohaCare Medicaid |
$63.34
|
| Rate for Payer: AlohaCare Medicare |
$50.78
|
| Rate for Payer: Cash Price |
$150.61
|
| Rate for Payer: Cash Price |
$150.61
|
| Rate for Payer: Devoted Health Medicare |
$55.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$63.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$105.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.40
|
| Rate for Payer: Health Management Network Commercial |
$213.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$63.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.78
|
| Rate for Payer: University Health Alliance Commercial |
$72.32
|
|
|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$285.32
|
|
|
Service Code
|
HCPCS 11312
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$242.52 |
| Rate for Payer: AlohaCare Medicaid |
$74.96
|
| Rate for Payer: AlohaCare Medicare |
$60.50
|
| Rate for Payer: Cash Price |
$171.19
|
| Rate for Payer: Cash Price |
$171.19
|
| Rate for Payer: Devoted Health Medicare |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$74.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$124.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.26
|
| Rate for Payer: Health Management Network Commercial |
$242.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.50
|
| Rate for Payer: University Health Alliance Commercial |
$85.60
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 11301
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Kaiser Permanente Medicaid |
$50.34
|
| Rate for Payer: AlohaCare Medicaid |
$51.71
|
| Rate for Payer: AlohaCare Medicare |
$41.95
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Devoted Health Medicare |
$46.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$86.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.95
|
| Rate for Payer: University Health Alliance Commercial |
$59.21
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Professional
|
Both
|
$279.07
|
|
|
Service Code
|
HCPCS 11303
|
| Min. Negotiated Rate |
$57.69 |
| Max. Negotiated Rate |
$237.21 |
| Rate for Payer: AlohaCare Medicaid |
$71.76
|
| Rate for Payer: AlohaCare Medicare |
$57.69
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Devoted Health Medicare |
$63.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$118.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$237.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.69
|
| Rate for Payer: University Health Alliance Commercial |
$81.91
|
|
|
PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 11302
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: AlohaCare Medicaid |
$60.34
|
| Rate for Payer: AlohaCare Medicare |
$48.72
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Devoted Health Medicare |
$53.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$60.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$100.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$60.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.22
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.72
|
| Rate for Payer: University Health Alliance Commercial |
$69.50
|
|
|
PR SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL
|
Professional
|
Both
|
$444.82
|
|
|
Service Code
|
HCPCS 42330
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: AlohaCare Medicaid |
$174.15
|
| Rate for Payer: AlohaCare Medicare |
$154.68
|
| Rate for Payer: Cash Price |
$266.89
|
| Rate for Payer: Cash Price |
$266.89
|
| Rate for Payer: Devoted Health Medicare |
$170.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$174.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$286.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$378.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$174.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.68
|
| Rate for Payer: University Health Alliance Commercial |
$225.56
|
|
|
PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES
|
Professional
|
Both
|
$4,930.15
|
|
|
Service Code
|
HCPCS 45346
|
| Min. Negotiated Rate |
$144.05 |
| Max. Negotiated Rate |
$4,190.63 |
| Rate for Payer: AlohaCare Medicare |
$144.05
|
| Rate for Payer: Cash Price |
$2,958.09
|
| Rate for Payer: Cash Price |
$2,958.09
|
| Rate for Payer: Devoted Health Medicare |
$158.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$160.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$278.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$372.84
|
| Rate for Payer: Health Management Network Commercial |
$4,190.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.05
|
| Rate for Payer: University Health Alliance Commercial |
$212.38
|
|
|
PR SIGMOIDOSCOPY FLX CONTROL BLEEDING
|
Professional
|
Both
|
$1,060.50
|
|
|
Service Code
|
HCPCS 45334
|
| Min. Negotiated Rate |
$107.36 |
| Max. Negotiated Rate |
$901.42 |
| Rate for Payer: AlohaCare Medicaid |
$118.48
|
| Rate for Payer: AlohaCare Medicare |
$107.36
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Devoted Health Medicare |
$118.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$246.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.92
|
| Rate for Payer: Health Management Network Commercial |
$901.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.36
|
|
|
PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$418.18
|
|
|
Service Code
|
HCPCS 45330
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$355.45 |
| Rate for Payer: AlohaCare Medicaid |
$58.12
|
| Rate for Payer: AlohaCare Medicare |
$55.15
|
| Rate for Payer: Cash Price |
$250.91
|
| Rate for Payer: Cash Price |
$250.91
|
| Rate for Payer: Devoted Health Medicare |
$60.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$95.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$118.04
|
| Rate for Payer: Health Management Network Commercial |
$355.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.15
|
| Rate for Payer: University Health Alliance Commercial |
$72.43
|
|
|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$629.21
|
|
|
Service Code
|
HCPCS 45331
|
| Min. Negotiated Rate |
$68.27 |
| Max. Negotiated Rate |
$534.83 |
| Rate for Payer: AlohaCare Medicaid |
$73.64
|
| Rate for Payer: AlohaCare Medicare |
$68.27
|
| Rate for Payer: Cash Price |
$377.53
|
| Rate for Payer: Cash Price |
$377.53
|
| Rate for Payer: Devoted Health Medicare |
$75.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$121.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.96
|
| Rate for Payer: Health Management Network Commercial |
$534.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.27
|
| Rate for Payer: University Health Alliance Commercial |
$91.58
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$601.77
|
|
|
Service Code
|
HCPCS 45332
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$511.50 |
| Rate for Payer: AlohaCare Medicaid |
$106.29
|
| Rate for Payer: AlohaCare Medicare |
$97.02
|
| Rate for Payer: Cash Price |
$361.06
|
| Rate for Payer: Cash Price |
$361.06
|
| Rate for Payer: Devoted Health Medicare |
$106.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$177.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.62
|
| Rate for Payer: Health Management Network Commercial |
$511.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.02
|
| Rate for Payer: University Health Alliance Commercial |
$131.41
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$713.77
|
|
|
Service Code
|
HCPCS 45333
|
| Min. Negotiated Rate |
$87.35 |
| Max. Negotiated Rate |
$606.70 |
| Rate for Payer: AlohaCare Medicaid |
$94.71
|
| Rate for Payer: AlohaCare Medicare |
$87.35
|
| Rate for Payer: Cash Price |
$428.26
|
| Rate for Payer: Cash Price |
$428.26
|
| Rate for Payer: Devoted Health Medicare |
$96.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$606.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.35
|
| Rate for Payer: University Health Alliance Commercial |
$124.56
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$492.20
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$418.37 |
| Rate for Payer: AlohaCare Medicaid |
$121.86
|
| Rate for Payer: AlohaCare Medicare |
$115.68
|
| Rate for Payer: Cash Price |
$295.32
|
| Rate for Payer: Cash Price |
$295.32
|
| Rate for Payer: Devoted Health Medicare |
$127.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$121.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$299.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.60
|
| Rate for Payer: Health Management Network Commercial |
$418.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.68
|
| Rate for Payer: University Health Alliance Commercial |
$144.24
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$256.78
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$146.66 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: AlohaCare Medicaid |
$146.66
|
| Rate for Payer: AlohaCare Medicare |
$146.73
|
| Rate for Payer: Cash Price |
$154.07
|
| Rate for Payer: Cash Price |
$154.07
|
| Rate for Payer: Devoted Health Medicare |
$161.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.70
|
| Rate for Payer: Health Management Network Commercial |
$218.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$146.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.73
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$261.98
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$222.68 |
| Rate for Payer: AlohaCare Medicaid |
$54.07
|
| Rate for Payer: AlohaCare Medicare |
$52.86
|
| Rate for Payer: Cash Price |
$157.19
|
| Rate for Payer: Cash Price |
$157.19
|
| Rate for Payer: Devoted Health Medicare |
$58.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$146.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.08
|
| Rate for Payer: Health Management Network Commercial |
$222.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.86
|
| Rate for Payer: University Health Alliance Commercial |
$62.33
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$271.42
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$230.71 |
| Rate for Payer: AlohaCare Medicaid |
$55.42
|
| Rate for Payer: AlohaCare Medicare |
$52.94
|
| Rate for Payer: Cash Price |
$162.85
|
| Rate for Payer: Cash Price |
$162.85
|
| Rate for Payer: Devoted Health Medicare |
$58.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$167.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$230.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.94
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$289.36
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$165.14 |
| Max. Negotiated Rate |
$320.84 |
| Rate for Payer: AlohaCare Medicaid |
$165.14
|
| Rate for Payer: AlohaCare Medicare |
$165.35
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Cash Price |
$173.62
|
| Rate for Payer: Devoted Health Medicare |
$181.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.84
|
| Rate for Payer: Health Management Network Commercial |
$245.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.35
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$319.60
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$271.66 |
| Rate for Payer: AlohaCare Medicaid |
$71.62
|
| Rate for Payer: AlohaCare Medicare |
$68.32
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Devoted Health Medicare |
$75.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$271.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.32
|
| Rate for Payer: University Health Alliance Commercial |
$83.44
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$390.22
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$331.69 |
| Rate for Payer: AlohaCare Medicaid |
$89.83
|
| Rate for Payer: AlohaCare Medicare |
$85.51
|
| Rate for Payer: Cash Price |
$234.13
|
| Rate for Payer: Cash Price |
$234.13
|
| Rate for Payer: Devoted Health Medicare |
$94.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$248.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$89.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$147.16
|
| Rate for Payer: Health Management Network Commercial |
$331.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.51
|
| Rate for Payer: University Health Alliance Commercial |
$105.37
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$214.85
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$43.02 |
| Max. Negotiated Rate |
$182.62 |
| Rate for Payer: AlohaCare Medicaid |
$43.95
|
| Rate for Payer: AlohaCare Medicare |
$43.02
|
| Rate for Payer: Cash Price |
$128.91
|
| Rate for Payer: Cash Price |
$128.91
|
| Rate for Payer: Devoted Health Medicare |
$47.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$43.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$140.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$182.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.02
|
| Rate for Payer: University Health Alliance Commercial |
$131.00
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$466.86
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$396.83 |
| Rate for Payer: AlohaCare Medicaid |
$138.73
|
| Rate for Payer: AlohaCare Medicare |
$127.78
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Devoted Health Medicare |
$140.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$325.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$396.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.78
|
| Rate for Payer: University Health Alliance Commercial |
$163.91
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$300.35
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$255.30 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$69.47
|
| Rate for Payer: Cash Price |
$180.21
|
| Rate for Payer: Cash Price |
$180.21
|
| Rate for Payer: Devoted Health Medicare |
$76.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$71.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$183.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$71.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.06
|
| Rate for Payer: Health Management Network Commercial |
$255.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.47
|
| Rate for Payer: University Health Alliance Commercial |
$82.18
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 51736 TC
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$6.65
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Devoted Health Medicare |
$7.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.65
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 51736 26
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$8.72
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Devoted Health Medicare |
$9.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.72
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$927.35 |
| Rate for Payer: AlohaCare Medicaid |
$14.45
|
| Rate for Payer: AlohaCare Medicare |
$15.37
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Devoted Health Medicare |
$16.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.38
|
| Rate for Payer: Health Management Network Commercial |
$927.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.37
|
|
