|
PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 27337
|
| Min. Negotiated Rate |
$411.81 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: AlohaCare Medicaid |
$430.95
|
| Rate for Payer: AlohaCare Medicare |
$411.81
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Devoted Health Medicare |
$452.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$411.81
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$494.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$494.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$430.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$411.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$430.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$411.81
|
|
|
PR EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$531.05
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$451.39 |
| Rate for Payer: AlohaCare Medicaid |
$164.92
|
| Rate for Payer: AlohaCare Medicare |
$140.16
|
| Rate for Payer: Cash Price |
$318.63
|
| Rate for Payer: Cash Price |
$318.63
|
| Rate for Payer: Devoted Health Medicare |
$154.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$164.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$164.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.00
|
| Rate for Payer: Health Management Network Commercial |
$451.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$168.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$164.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.16
|
| Rate for Payer: University Health Alliance Commercial |
$213.16
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$719.14
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$199.94 |
| Max. Negotiated Rate |
$611.27 |
| Rate for Payer: AlohaCare Medicaid |
$300.58
|
| Rate for Payer: AlohaCare Medicare |
$276.88
|
| Rate for Payer: Cash Price |
$431.48
|
| Rate for Payer: Cash Price |
$431.48
|
| Rate for Payer: Devoted Health Medicare |
$304.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$300.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$463.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$276.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$300.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.94
|
| Rate for Payer: Health Management Network Commercial |
$611.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$332.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$276.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$300.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$276.88
|
| Rate for Payer: University Health Alliance Commercial |
$392.28
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$531.63
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$154.44 |
| Max. Negotiated Rate |
$451.89 |
| Rate for Payer: AlohaCare Medicaid |
$192.75
|
| Rate for Payer: AlohaCare Medicare |
$175.43
|
| Rate for Payer: Cash Price |
$318.98
|
| Rate for Payer: Cash Price |
$318.98
|
| Rate for Payer: Devoted Health Medicare |
$192.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$192.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$302.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$192.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.44
|
| Rate for Payer: Health Management Network Commercial |
$451.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$210.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$192.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.43
|
| Rate for Payer: University Health Alliance Commercial |
$239.53
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$414.26
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$352.12 |
| Rate for Payer: AlohaCare Medicaid |
$143.17
|
| Rate for Payer: AlohaCare Medicare |
$127.72
|
| Rate for Payer: Cash Price |
$248.56
|
| Rate for Payer: Cash Price |
$248.56
|
| Rate for Payer: Devoted Health Medicare |
$140.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$143.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$218.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$143.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$352.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.72
|
| Rate for Payer: University Health Alliance Commercial |
$185.03
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$494.76
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$129.74 |
| Max. Negotiated Rate |
$420.55 |
| Rate for Payer: AlohaCare Medicaid |
$169.37
|
| Rate for Payer: AlohaCare Medicare |
$155.87
|
| Rate for Payer: Cash Price |
$296.86
|
| Rate for Payer: Cash Price |
$296.86
|
| Rate for Payer: Devoted Health Medicare |
$171.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$169.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$265.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$129.74
|
| Rate for Payer: Health Management Network Commercial |
$420.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$169.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.87
|
| Rate for Payer: University Health Alliance Commercial |
$225.13
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,259.86
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$1,070.88 |
| Rate for Payer: AlohaCare Medicaid |
$341.51
|
| Rate for Payer: AlohaCare Medicare |
$322.68
|
| Rate for Payer: Cash Price |
$755.92
|
| Rate for Payer: Cash Price |
$755.92
|
| Rate for Payer: Devoted Health Medicare |
$354.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$341.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$517.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$322.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$341.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$1,070.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$387.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$341.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$341.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.68
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$883.21
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$305.69 |
| Max. Negotiated Rate |
$750.73 |
| Rate for Payer: AlohaCare Medicaid |
$326.23
|
| Rate for Payer: AlohaCare Medicare |
$305.69
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Devoted Health Medicare |
$336.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$326.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$492.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$305.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$326.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$310.18
|
| Rate for Payer: Health Management Network Commercial |
$750.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$366.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.69
|
| Rate for Payer: University Health Alliance Commercial |
$406.36
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$647.38
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$550.27 |
| Rate for Payer: AlohaCare Medicaid |
$259.27
|
| Rate for Payer: AlohaCare Medicare |
$237.01
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Cash Price |
$388.43
|
| Rate for Payer: Devoted Health Medicare |
$260.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$259.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$398.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$259.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.62
|
| Rate for Payer: Health Management Network Commercial |
$550.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$284.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$284.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$259.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.01
|
| Rate for Payer: University Health Alliance Commercial |
$337.15
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$692.65
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$196.04 |
| Max. Negotiated Rate |
$588.75 |
| Rate for Payer: AlohaCare Medicaid |
$280.11
|
| Rate for Payer: AlohaCare Medicare |
$255.67
|
| Rate for Payer: Cash Price |
$415.59
|
| Rate for Payer: Cash Price |
$415.59
|
| Rate for Payer: Devoted Health Medicare |
$281.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$280.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$433.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$280.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$196.04
|
| Rate for Payer: Health Management Network Commercial |
$588.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.67
|
| Rate for Payer: University Health Alliance Commercial |
$367.09
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$411.83
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$350.06 |
| Rate for Payer: AlohaCare Medicaid |
$130.24
|
| Rate for Payer: AlohaCare Medicare |
$116.46
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Devoted Health Medicare |
$128.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$195.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$130.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.64
|
| Rate for Payer: Health Management Network Commercial |
$350.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.46
|
| Rate for Payer: University Health Alliance Commercial |
$165.71
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR
|
Professional
|
Both
|
$569.19
|
|
|
Service Code
|
HCPCS 41826
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$483.81 |
| Rate for Payer: AlohaCare Medicaid |
$207.48
|
| Rate for Payer: AlohaCare Medicare |
$187.40
|
| Rate for Payer: Cash Price |
$341.51
|
| Rate for Payer: Cash Price |
$341.51
|
| Rate for Payer: Devoted Health Medicare |
$206.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$207.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$325.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$207.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$167.18
|
| Rate for Payer: Health Management Network Commercial |
$483.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$224.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.40
|
| Rate for Payer: University Health Alliance Commercial |
$275.35
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$413.47
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$81.38 |
| Max. Negotiated Rate |
$351.45 |
| Rate for Payer: AlohaCare Medicaid |
$131.44
|
| Rate for Payer: AlohaCare Medicare |
$121.20
|
| Rate for Payer: Cash Price |
$248.08
|
| Rate for Payer: Cash Price |
$248.08
|
| Rate for Payer: Devoted Health Medicare |
$133.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$131.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$131.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.38
|
| Rate for Payer: Health Management Network Commercial |
$351.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.20
|
| Rate for Payer: University Health Alliance Commercial |
$162.93
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$487.24 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$575.60
|
| Rate for Payer: AlohaCare Medicare |
$509.41
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Devoted Health Medicare |
$560.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$509.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.24
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$611.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$611.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$611.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$575.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$509.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$575.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$509.41
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$931.44
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$791.72 |
| Rate for Payer: AlohaCare Medicaid |
$367.06
|
| Rate for Payer: AlohaCare Medicare |
$326.41
|
| Rate for Payer: Cash Price |
$558.86
|
| Rate for Payer: Cash Price |
$558.86
|
| Rate for Payer: Devoted Health Medicare |
$359.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$367.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$563.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$367.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.88
|
| Rate for Payer: Health Management Network Commercial |
$791.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$391.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$367.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.41
|
| Rate for Payer: University Health Alliance Commercial |
$476.87
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$1,762.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,211.21
|
| Rate for Payer: AlohaCare Medicare |
$1,123.04
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Devoted Health Medicare |
$1,235.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,123.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.64
|
| Rate for Payer: Health Management Network Commercial |
$1,762.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,347.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,347.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,347.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,211.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,123.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,211.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,123.04
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: AlohaCare Medicaid |
$963.41
|
| Rate for Payer: AlohaCare Medicare |
$897.13
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Devoted Health Medicare |
$986.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$897.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$569.40
|
| Rate for Payer: Health Management Network Commercial |
$1,398.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,076.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,076.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,076.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$963.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$963.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.13
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$636.22 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: AlohaCare Medicaid |
$779.22
|
| Rate for Payer: AlohaCare Medicare |
$733.18
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Devoted Health Medicare |
$806.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$733.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.22
|
| Rate for Payer: Health Management Network Commercial |
$1,130.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$879.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$879.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$779.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$733.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$779.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$733.18
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$320.84 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: AlohaCare Medicaid |
$428.86
|
| Rate for Payer: AlohaCare Medicare |
$401.38
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Devoted Health Medicare |
$441.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$320.84
|
| Rate for Payer: Health Management Network Commercial |
$623.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$428.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$428.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.38
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$306.28 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: AlohaCare Medicaid |
$424.65
|
| Rate for Payer: AlohaCare Medicare |
$383.78
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Devoted Health Medicare |
$422.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$383.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.28
|
| Rate for Payer: Health Management Network Commercial |
$615.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$460.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$460.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$460.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$424.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$383.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$383.78
|
|
|
PR EXC PENILE PLAQUE GRAFT > 5 CM LENGTH
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 54112
|
| Min. Negotiated Rate |
$771.68 |
| Max. Negotiated Rate |
$1,375.30 |
| Rate for Payer: AlohaCare Medicaid |
$944.28
|
| Rate for Payer: AlohaCare Medicare |
$843.44
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Devoted Health Medicare |
$927.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$843.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$771.68
|
| Rate for Payer: Health Management Network Commercial |
$1,375.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,012.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,012.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$944.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$843.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$944.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$843.44
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,852.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$922.93 |
| Max. Negotiated Rate |
$1,574.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,084.68
|
| Rate for Payer: AlohaCare Medicare |
$922.93
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Devoted Health Medicare |
$1,015.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,157.52
|
| Rate for Payer: Health Management Network Commercial |
$1,574.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,084.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,084.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.93
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,111.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: AlohaCare Medicaid |
$651.40
|
| Rate for Payer: AlohaCare Medicare |
$563.74
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Devoted Health Medicare |
$620.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$563.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.00
|
| Rate for Payer: Health Management Network Commercial |
$944.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$676.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$676.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$676.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$651.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$563.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$651.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$563.74
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,068.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$1,026.40 |
| Max. Negotiated Rate |
$1,757.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,210.85
|
| Rate for Payer: AlohaCare Medicare |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Devoted Health Medicare |
$1,129.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,026.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,341.08
|
| Rate for Payer: Health Management Network Commercial |
$1,757.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,231.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,231.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,231.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,210.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,026.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,210.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,026.40
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ
|
Professional
|
Both
|
$2,339.00
|
|
|
Service Code
|
HCPCS 42426
|
| Min. Negotiated Rate |
$1,159.83 |
| Max. Negotiated Rate |
$1,988.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,370.43
|
| Rate for Payer: AlohaCare Medicare |
$1,159.83
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Devoted Health Medicare |
$1,275.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,159.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,311.18
|
| Rate for Payer: Health Management Network Commercial |
$1,988.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,391.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,391.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,391.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,370.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,159.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,370.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,159.83
|
|
