|
EVAL ORAL&PHARYNGEAL SWLNG FUNCJ
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92610
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: AlohaCare Medicaid |
$73.09
|
| Rate for Payer: AlohaCare Medicare |
$59.56
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Devoted Health Medicare |
$59.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$73.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$108.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.61
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.56
|
|
|
EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
HCPCS 92523
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: AlohaCare Medicaid |
$240.61
|
| Rate for Payer: AlohaCare Medicare |
$239.72
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$239.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.16
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$287.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.72
|
|
|
EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 92521
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$334.90 |
| Rate for Payer: AlohaCare Medicaid |
$140.32
|
| Rate for Payer: AlohaCare Medicare |
$141.09
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Devoted Health Medicare |
$141.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.85
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.09
|
|
|
EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 92522
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: AlohaCare Medicaid |
$116.85
|
| Rate for Payer: AlohaCare Medicare |
$117.69
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Devoted Health Medicare |
$117.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.51
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.69
|
|
|
everolimus 10 mg Tab [KMC]
|
Facility
|
OP
|
$2,692.58
|
|
|
Service Code
|
HCPCS J7527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2,611.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,346.29
|
| Rate for Payer: AlohaCare Medicare |
$1,130.88
|
| Rate for Payer: Cash Price |
$1,750.18
|
| Rate for Payer: Cash Price |
$1,750.18
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2,477.17
|
| Rate for Payer: Devoted Health Medicare |
$1,130.88
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$1.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,557.95
|
| Rate for Payer: Health Management Network Commercial |
$2,288.69
|
| Rate for Payer: Humana Medicare |
$1,130.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,423.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,373.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.88
|
| Rate for Payer: MDX Hawaii PPO |
$2,611.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,615.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.88
|
| Rate for Payer: University Health Alliance Commercial |
$1,962.62
|
|
|
everolimus 10 mg Tab [KMC]
|
Facility
|
IP
|
$2,692.58
|
|
|
Service Code
|
HCPCS J7527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,288.69 |
| Max. Negotiated Rate |
$2,611.80 |
| Rate for Payer: Cash Price |
$1,750.18
|
| Rate for Payer: Health Management Network Commercial |
$2,288.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,423.32
|
| Rate for Payer: MDX Hawaii PPO |
$2,611.80
|
|
|
EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$116.56
|
| Rate for Payer: AlohaCare Medicare |
$104.55
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$104.55
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$83.98
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$327.38
|
| Rate for Payer: AlohaCare Medicare |
$287.19
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$287.19
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$114.40
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 11420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$1,987.30 |
| Rate for Payer: AlohaCare Medicaid |
$87.79
|
| Rate for Payer: AlohaCare Medicare |
$79.96
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Devoted Health Medicare |
$79.96
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$70.98
|
| Rate for Payer: Health Management Network Commercial |
$1,987.30
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 11421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$1,987.30 |
| Rate for Payer: AlohaCare Medicaid |
$115.22
|
| Rate for Payer: AlohaCare Medicare |
$102.70
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Devoted Health Medicare |
$102.70
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$96.46
|
| Rate for Payer: Health Management Network Commercial |
$1,987.30
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$165.79
|
| Rate for Payer: AlohaCare Medicare |
$149.07
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$149.07
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$189.29
|
| Rate for Payer: AlohaCare Medicare |
$169.64
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$169.64
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$160.16
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$275.66
|
| Rate for Payer: AlohaCare Medicare |
$248.18
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$248.18
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$90.72
|
| Rate for Payer: AlohaCare Medicare |
$80.89
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$80.89
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$69.42
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 11403
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$1,987.30 |
| Rate for Payer: AlohaCare Medicaid |
$158.47
|
| Rate for Payer: AlohaCare Medicare |
$141.34
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Cash Price |
$1,519.70
|
| Rate for Payer: Devoted Health Medicare |
$141.34
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$125.58
|
| Rate for Payer: Health Management Network Commercial |
$1,987.30
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11404
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$172.77
|
| Rate for Payer: AlohaCare Medicare |
$156.66
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$156.66
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| 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
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$256.10
|
| Rate for Payer: AlohaCare Medicare |
$231.38
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$231.38
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| 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
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$142.63
|
| Rate for Payer: AlohaCare Medicare |
$126.36
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$126.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-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 Western Management Group Commercial |
$106.34
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| 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
|
|
|
EXCISION BENIGN LESION SCALP, NECK, HANDS, FEET, G
|
Facility
|
IP
|
$5,853.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
440114240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,975.05 |
| Max. Negotiated Rate |
$5,677.41 |
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Health Management Network Commercial |
$4,975.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,267.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,677.41
|
|
|
EXCISION BENIGN LESION SCALP, NECK, HANDS, FEET, G
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
440114240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$5,677.41 |
| Rate for Payer: AlohaCare Medicaid |
$2,926.50
|
| Rate for Payer: AlohaCare Medicare |
$2,458.26
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,384.76
|
| Rate for Payer: Devoted Health Medicare |
$2,458.26
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,458.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,560.35
|
| Rate for Payer: Health Management Network Commercial |
$4,975.05
|
| Rate for Payer: Humana Medicare |
$2,458.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,267.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,458.26
|
| Rate for Payer: MDX Hawaii PPO |
$5,677.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,458.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,458.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,458.26
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
EXCISION, BEN LES, 1.1 - 2 CM CHARGE
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
440114020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,383.80 |
| Max. Negotiated Rate |
$1,579.16 |
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Health Management Network Commercial |
$1,383.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,465.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,579.16
|
|
|
EXCISION, BEN LES, 1.1 - 2 CM CHARGE
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
440114020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$814.00
|
| Rate for Payer: AlohaCare Medicare |
$683.76
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Cash Price |
$1,058.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,497.76
|
| Rate for Payer: Devoted Health Medicare |
$683.76
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$683.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,546.60
|
| Rate for Payer: Health Management Network Commercial |
$1,383.80
|
| Rate for Payer: Humana Medicare |
$683.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,465.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$683.76
|
| Rate for Payer: MDX Hawaii PPO |
$1,579.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$683.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$683.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$683.76
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$342.67
|
| Rate for Payer: AlohaCare Medicare |
$325.41
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$325.41
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$342.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$526.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$325.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.20
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$325.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$325.41
|
| Rate for Payer: University Health Alliance Commercial |
$390.31
|
|
|
EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$273.23
|
| Rate for Payer: AlohaCare Medicare |
$261.98
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$261.98
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$273.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$410.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.64
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$314.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$314.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$314.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$273.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.98
|
| Rate for Payer: University Health Alliance Commercial |
$311.65
|
|
|
EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$260.96
|
| Rate for Payer: AlohaCare Medicare |
$250.76
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$250.76
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$260.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$399.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$300.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$260.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.76
|
| Rate for Payer: University Health Alliance Commercial |
$297.27
|
|
