|
PR EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR
|
Professional
|
Both
|
$27,890.00
|
|
|
Service Code
|
HCPCS 0505T
|
| Min. Negotiated Rate |
$843.82 |
| Max. Negotiated Rate |
$23,706.50 |
| Rate for Payer: Cash Price |
$16,734.00
|
| Rate for Payer: Cash Price |
$16,734.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$843.82
|
| Rate for Payer: Health Management Network Commercial |
$23,706.50
|
|
|
PR EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 92558
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$270.69
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$230.09 |
| Rate for Payer: AlohaCare Medicaid |
$116.56
|
| Rate for Payer: AlohaCare Medicare |
$104.55
|
| Rate for Payer: Cash Price |
$162.41
|
| Rate for Payer: Cash Price |
$162.41
|
| Rate for Payer: Devoted Health Medicare |
$115.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$173.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$116.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.98
|
| Rate for Payer: Health Management Network Commercial |
$230.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.55
|
| Rate for Payer: University Health Alliance Commercial |
$126.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$733.20
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$623.22 |
| Rate for Payer: AlohaCare Medicaid |
$327.38
|
| Rate for Payer: AlohaCare Medicare |
$287.19
|
| Rate for Payer: Cash Price |
$439.92
|
| Rate for Payer: Cash Price |
$439.92
|
| Rate for Payer: Devoted Health Medicare |
$315.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$327.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$507.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$327.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.40
|
| Rate for Payer: Health Management Network Commercial |
$623.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$344.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$344.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$327.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.19
|
| Rate for Payer: University Health Alliance Commercial |
$357.86
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$236.97
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$201.42 |
| Rate for Payer: AlohaCare Medicaid |
$87.79
|
| Rate for Payer: AlohaCare Medicare |
$79.96
|
| Rate for Payer: Cash Price |
$142.18
|
| Rate for Payer: Cash Price |
$142.18
|
| Rate for Payer: Devoted Health Medicare |
$87.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.98
|
| Rate for Payer: Health Management Network Commercial |
$201.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.96
|
| Rate for Payer: University Health Alliance Commercial |
$95.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$300.02
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$255.02 |
| Rate for Payer: AlohaCare Medicaid |
$115.22
|
| Rate for Payer: AlohaCare Medicare |
$102.70
|
| Rate for Payer: Cash Price |
$180.01
|
| Rate for Payer: Cash Price |
$180.01
|
| Rate for Payer: Devoted Health Medicare |
$112.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$115.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$115.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.46
|
| Rate for Payer: Health Management Network Commercial |
$255.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.70
|
| Rate for Payer: University Health Alliance Commercial |
$125.31
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$337.58
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$286.94 |
| Rate for Payer: AlohaCare Medicaid |
$144.37
|
| Rate for Payer: AlohaCare Medicare |
$129.86
|
| Rate for Payer: Cash Price |
$202.55
|
| Rate for Payer: Cash Price |
$202.55
|
| Rate for Payer: Devoted Health Medicare |
$142.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$144.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$218.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$144.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.14
|
| Rate for Payer: Health Management Network Commercial |
$286.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.86
|
| Rate for Payer: University Health Alliance Commercial |
$157.79
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$390.48
|
|
|
Service Code
|
HCPCS 11423
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$331.91 |
| Rate for Payer: AlohaCare Medicaid |
$165.79
|
| Rate for Payer: AlohaCare Medicare |
$149.07
|
| Rate for Payer: Cash Price |
$234.29
|
| Rate for Payer: Cash Price |
$234.29
|
| Rate for Payer: Devoted Health Medicare |
$163.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$249.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network Commercial |
$331.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.07
|
| Rate for Payer: University Health Alliance Commercial |
$181.51
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$453.70
|
|
|
Service Code
|
HCPCS 11424
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$385.64 |
| Rate for Payer: AlohaCare Medicaid |
$189.29
|
| Rate for Payer: AlohaCare Medicare |
$169.64
|
| Rate for Payer: Cash Price |
$272.22
|
| Rate for Payer: Cash Price |
$272.22
|
| Rate for Payer: Devoted Health Medicare |
$186.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$283.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.16
|
| Rate for Payer: Health Management Network Commercial |
$385.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$203.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.64
|
| Rate for Payer: University Health Alliance Commercial |
$206.64
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$623.74
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$530.18 |
| Rate for Payer: AlohaCare Medicaid |
$275.66
|
| Rate for Payer: AlohaCare Medicare |
$248.18
|
| Rate for Payer: Cash Price |
$374.24
|
| Rate for Payer: Cash Price |
$374.24
|
| Rate for Payer: Devoted Health Medicare |
$273.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$275.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$430.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$275.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network Commercial |
$530.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$297.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$275.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.18
|
| Rate for Payer: University Health Alliance Commercial |
$301.65
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$243.90
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$207.31 |
| Rate for Payer: AlohaCare Medicaid |
$90.72
|
| Rate for Payer: AlohaCare Medicare |
$80.89
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Devoted Health Medicare |
$88.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$132.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.42
|
| Rate for Payer: Health Management Network Commercial |
$207.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.89
|
| Rate for Payer: University Health Alliance Commercial |
$105.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$293.14
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$249.17 |
| Rate for Payer: AlohaCare Medicaid |
$112.53
|
| Rate for Payer: AlohaCare Medicare |
$98.77
|
| Rate for Payer: Cash Price |
$175.88
|
| Rate for Payer: Cash Price |
$175.88
|
| Rate for Payer: Devoted Health Medicare |
$108.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.66
|
| Rate for Payer: Health Management Network Commercial |
$249.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.77
|
| Rate for Payer: University Health Alliance Commercial |
$122.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$323.10
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$274.63 |
| Rate for Payer: AlohaCare Medicaid |
$122.57
|
| Rate for Payer: AlohaCare Medicare |
$106.78
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Devoted Health Medicare |
$117.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$186.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.12
|
| Rate for Payer: Health Management Network Commercial |
$274.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.78
|
| Rate for Payer: University Health Alliance Commercial |
$133.24
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$374.94
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$318.70 |
| Rate for Payer: AlohaCare Medicaid |
$158.47
|
| Rate for Payer: AlohaCare Medicare |
$141.34
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Devoted Health Medicare |
$155.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$239.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.58
|
| Rate for Payer: Health Management Network Commercial |
$318.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.34
|
| Rate for Payer: University Health Alliance Commercial |
$172.78
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$431.66
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$366.91 |
| Rate for Payer: AlohaCare Medicaid |
$172.77
|
| Rate for Payer: AlohaCare Medicare |
$156.66
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Devoted Health Medicare |
$172.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$366.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.66
|
| Rate for Payer: University Health Alliance Commercial |
$188.62
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$615.58
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$523.24 |
| Rate for Payer: AlohaCare Medicaid |
$256.10
|
| Rate for Payer: AlohaCare Medicare |
$231.38
|
| Rate for Payer: Cash Price |
$369.35
|
| Rate for Payer: Cash Price |
$369.35
|
| Rate for Payer: Devoted Health Medicare |
$254.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$393.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$523.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.38
|
| Rate for Payer: University Health Alliance Commercial |
$279.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$327.46
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$278.34 |
| Rate for Payer: AlohaCare Medicaid |
$142.63
|
| Rate for Payer: AlohaCare Medicare |
$126.36
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Devoted Health Medicare |
$139.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.34
|
| Rate for Payer: Health Management Network Commercial |
$278.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.36
|
| Rate for Payer: University Health Alliance Commercial |
$154.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$365.10
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$310.33 |
| Rate for Payer: AlohaCare Medicaid |
$156.34
|
| Rate for Payer: AlohaCare Medicare |
$137.99
|
| Rate for Payer: Cash Price |
$219.06
|
| Rate for Payer: Cash Price |
$219.06
|
| Rate for Payer: Devoted Health Medicare |
$151.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$156.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$236.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$156.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.10
|
| Rate for Payer: Health Management Network Commercial |
$310.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$156.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$156.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.99
|
| Rate for Payer: University Health Alliance Commercial |
$170.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$429.87
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$365.39 |
| Rate for Payer: AlohaCare Medicaid |
$188.67
|
| Rate for Payer: AlohaCare Medicare |
$165.13
|
| Rate for Payer: Cash Price |
$257.92
|
| Rate for Payer: Cash Price |
$257.92
|
| Rate for Payer: Devoted Health Medicare |
$181.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$188.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$286.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$188.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.02
|
| Rate for Payer: Health Management Network Commercial |
$365.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.13
|
| Rate for Payer: University Health Alliance Commercial |
$205.35
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$534.61
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$148.72 |
| Max. Negotiated Rate |
$454.42 |
| Rate for Payer: AlohaCare Medicaid |
$235.27
|
| Rate for Payer: AlohaCare Medicare |
$205.24
|
| Rate for Payer: Cash Price |
$320.77
|
| Rate for Payer: Cash Price |
$320.77
|
| Rate for Payer: Devoted Health Medicare |
$225.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$235.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$360.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$235.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.72
|
| Rate for Payer: Health Management Network Commercial |
$454.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$235.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.24
|
| Rate for Payer: University Health Alliance Commercial |
$257.04
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$889.44
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$349.89 |
| Max. Negotiated Rate |
$756.02 |
| Rate for Payer: AlohaCare Medicaid |
$380.85
|
| Rate for Payer: AlohaCare Medicare |
$349.89
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Devoted Health Medicare |
$384.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$380.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$587.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$349.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$380.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$388.44
|
| Rate for Payer: Health Management Network Commercial |
$756.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$419.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$419.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$380.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$380.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.89
|
| Rate for Payer: University Health Alliance Commercial |
$500.00
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$491.63 |
| Max. Negotiated Rate |
$816.85 |
| Rate for Payer: AlohaCare Medicaid |
$565.07
|
| Rate for Payer: AlohaCare Medicare |
$491.63
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Devoted Health Medicare |
$540.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$491.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$598.00
|
| Rate for Payer: Health Management Network Commercial |
$816.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$589.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$589.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$565.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$491.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$565.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$491.63
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$727.18
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$268.58 |
| Max. Negotiated Rate |
$618.10 |
| Rate for Payer: AlohaCare Medicaid |
$302.57
|
| Rate for Payer: AlohaCare Medicare |
$269.32
|
| Rate for Payer: Cash Price |
$436.31
|
| Rate for Payer: Cash Price |
$436.31
|
| Rate for Payer: Devoted Health Medicare |
$296.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$302.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$460.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$302.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.58
|
| Rate for Payer: Health Management Network Commercial |
$618.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$302.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$302.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.32
|
| Rate for Payer: University Health Alliance Commercial |
$389.53
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,156.38
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$352.56 |
| Max. Negotiated Rate |
$982.92 |
| Rate for Payer: AlohaCare Medicaid |
$469.20
|
| Rate for Payer: AlohaCare Medicare |
$453.44
|
| Rate for Payer: Cash Price |
$693.83
|
| Rate for Payer: Cash Price |
$693.83
|
| Rate for Payer: Devoted Health Medicare |
$498.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$731.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$453.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$469.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$352.56
|
| Rate for Payer: Health Management Network Commercial |
$982.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$544.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$544.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$469.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$453.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$469.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$453.44
|
| Rate for Payer: University Health Alliance Commercial |
$510.63
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: AlohaCare Medicaid |
$153.42
|
| Rate for Payer: AlohaCare Medicare |
$136.99
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Devoted Health Medicare |
$150.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.66
|
| Rate for Payer: Health Management Network Commercial |
$222.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.99
|
|
