|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$145.78
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$123.91 |
| Rate for Payer: AlohaCare Medicaid |
$52.44
|
| Rate for Payer: AlohaCare Medicare |
$44.57
|
| Rate for Payer: Cash Price |
$87.47
|
| Rate for Payer: Cash Price |
$87.47
|
| Rate for Payer: Devoted Health Medicare |
$49.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$123.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.57
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$442.42
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$376.06 |
| Rate for Payer: AlohaCare Medicaid |
$153.95
|
| Rate for Payer: AlohaCare Medicare |
$137.36
|
| Rate for Payer: Cash Price |
$265.45
|
| Rate for Payer: Cash Price |
$265.45
|
| Rate for Payer: Devoted Health Medicare |
$151.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$316.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.22
|
| Rate for Payer: Health Management Network Commercial |
$376.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.36
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$137.99
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$117.29 |
| Rate for Payer: AlohaCare Medicaid |
$53.52
|
| Rate for Payer: AlohaCare Medicare |
$46.19
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Devoted Health Medicare |
$50.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$79.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.52
|
| Rate for Payer: Health Management Network Commercial |
$117.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.19
|
| Rate for Payer: University Health Alliance Commercial |
$62.70
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$61.67
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: AlohaCare Medicaid |
$13.89
|
| Rate for Payer: AlohaCare Medicare |
$12.45
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Devoted Health Medicare |
$13.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.74
|
| Rate for Payer: Health Management Network Commercial |
$52.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.45
|
| Rate for Payer: University Health Alliance Commercial |
$15.40
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$83.84
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.31
|
| Rate for Payer: AlohaCare Medicare |
$20.95
|
| Rate for Payer: Cash Price |
$50.30
|
| Rate for Payer: Cash Price |
$50.30
|
| Rate for Payer: Devoted Health Medicare |
$23.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.12
|
| Rate for Payer: Health Management Network Commercial |
$71.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.95
|
| Rate for Payer: University Health Alliance Commercial |
$25.55
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$194.41
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$165.25 |
| Rate for Payer: AlohaCare Medicaid |
$35.17
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.88
|
| Rate for Payer: Health Management Network Commercial |
$165.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.95
|
| Rate for Payer: University Health Alliance Commercial |
$145.00
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$89.16
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: AlohaCare Medicaid |
$24.27
|
| Rate for Payer: AlohaCare Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Devoted Health Medicare |
$23.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$72.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.18
|
| Rate for Payer: Health Management Network Commercial |
$75.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.32
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$252.42
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$214.56 |
| Rate for Payer: AlohaCare Medicaid |
$61.67
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$151.45
|
| Rate for Payer: Cash Price |
$151.45
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$214.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$77.53
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$65.90 |
| Rate for Payer: AlohaCare Medicaid |
$24.64
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.64
|
| Rate for Payer: Health Management Network Commercial |
$65.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$30.72
|
|
|
PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Professional
|
Both
|
$75.11
|
|
|
Service Code
|
HCPCS 36593
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: AlohaCare Medicaid |
$39.39
|
| Rate for Payer: AlohaCare Medicare |
$42.92
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Devoted Health Medicare |
$47.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.62
|
| Rate for Payer: Health Management Network Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.92
|
|
|
PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 27496
|
| Min. Negotiated Rate |
$332.02 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: AlohaCare Medicaid |
$582.29
|
| Rate for Payer: AlohaCare Medicare |
$547.49
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Devoted Health Medicare |
$602.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$547.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.02
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$656.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$656.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$656.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$582.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$547.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$582.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$547.49
|
|
|
PR DECOMPRESSIVE FASCIOTOMY HAND
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 26037
|
| Min. Negotiated Rate |
$538.67 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: AlohaCare Medicaid |
$588.86
|
| Rate for Payer: AlohaCare Medicare |
$538.67
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Devoted Health Medicare |
$592.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$538.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$572.00
|
| Rate for Payer: Health Management Network Commercial |
$862.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$646.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$646.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$646.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$588.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$538.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$588.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$538.67
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: AlohaCare Medicaid |
$142.57
|
| Rate for Payer: AlohaCare Medicare |
$123.75
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Devoted Health Medicare |
$136.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$147.18
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.75
|
|
|
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 |
$694.92
|
| 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 |
$132.09
|
| 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 |
$108.92
|
| 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 |
$342.75
|
| 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 |
$137.24
|
| 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 |
$150.20
|
| 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 |
$165.75
|
| 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 |
$191.67
|
| 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 |
$216.54
|
| 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
|
|
