|
EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$298.17
|
| Rate for Payer: AlohaCare Medicare |
$287.96
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$287.96
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$298.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$458.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$298.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$298.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.96
|
| Rate for Payer: University Health Alliance Commercial |
$339.29
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11644
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$288.00
|
| Rate for Payer: AlohaCare Medicare |
$242.32
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$242.32
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$288.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$242.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.60
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$242.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$288.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$242.32
|
| Rate for Payer: University Health Alliance Commercial |
$329.70
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$393.63
|
| Rate for Payer: AlohaCare Medicare |
$333.01
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$333.01
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$393.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$613.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$333.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.80
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$399.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$399.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$399.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$333.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$393.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$333.01
|
| Rate for Payer: University Health Alliance Commercial |
$454.10
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$243.81
|
| Rate for Payer: AlohaCare Medicare |
$205.80
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$205.80
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$243.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$375.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$255.58
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.80
|
| Rate for Payer: University Health Alliance Commercial |
$278.10
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.18 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$294.43
|
| Rate for Payer: AlohaCare Medicare |
$254.29
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$254.29
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$294.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$459.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$254.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$232.18
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$305.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$305.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$294.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$294.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$254.29
|
| Rate for Payer: University Health Alliance Commercial |
$346.49
|
|
|
EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$4,182.00
|
|
|
Service Code
|
HCPCS 11606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$3,554.70 |
| Rate for Payer: AlohaCare Medicaid |
$319.89
|
| Rate for Payer: AlohaCare Medicare |
$274.90
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Cash Price |
$2,718.30
|
| Rate for Payer: Devoted Health Medicare |
$274.90
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$319.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$497.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$274.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.38
|
| Rate for Payer: Health Management Network Commercial |
$3,554.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$329.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$329.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$319.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$274.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$319.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$274.90
|
| Rate for Payer: University Health Alliance Commercial |
$347.12
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.11 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$155.04
|
| Rate for Payer: AlohaCare Medicare |
$132.11
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$132.11
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$155.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$237.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.68
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.11
|
| Rate for Payer: University Health Alliance Commercial |
$175.48
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.93 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$168.58
|
| Rate for Payer: AlohaCare Medicare |
$140.93
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$140.93
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$168.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$257.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.04
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.93
|
| Rate for Payer: University Health Alliance Commercial |
$190.71
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 11750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: AlohaCare Medicaid |
$106.66
|
| Rate for Payer: AlohaCare Medicare |
$97.44
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Cash Price |
$757.25
|
| Rate for Payer: Devoted Health Medicare |
$97.44
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$106.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$236.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.02
|
| Rate for Payer: Health Management Network Commercial |
$990.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.44
|
| Rate for Payer: University Health Alliance Commercial |
$115.45
|
|
|
EXCISION OF BENIGN LESION CHARGE.
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
440114010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| 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 Medicare |
$683.76
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
EXCISION OF BENIGN LESION CHARGE.
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
440114010
|
|
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 OF LESION, < .5CM CHARGE
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
440114400
|
|
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 OF LESION, < .5CM CHARGE
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
440114400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 |
$1,186.65
|
|
|
EXCISION OF LESION CHARGE.
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
440113100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
|
|
EXCISION OF LESION CHARGE.
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
440113100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.50
|
| Rate for Payer: AlohaCare Medicare |
$180.18
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$394.68
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| 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 |
$180.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$407.55
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Humana Medicare |
$180.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.18
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.18
|
| Rate for Payer: University Health Alliance Commercial |
$312.70
|
|
|
EXCISION OF NAIL FOLD/INGROWN CHARGE
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
440117650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
|
|
EXCISION OF NAIL FOLD/INGROWN CHARGE
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
440117650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.50
|
| Rate for Payer: AlohaCare Medicare |
$180.18
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$394.68
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| 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 |
$180.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$407.55
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Humana Medicare |
$180.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.18
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.18
|
| Rate for Payer: University Health Alliance Commercial |
$312.70
|
|
|
EXCISION OF NAIL, PERMANENT CHARGE
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
440117500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 Medicare |
$683.76
|
| Rate for Payer: University Health Alliance Commercial |
$1,186.65
|
|
|
EXCISION OF NAIL, PERMANENT CHARGE
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
440117500
|
|
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 PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11771
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.32 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$463.32
|
| Rate for Payer: AlohaCare Medicare |
$448.60
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$448.60
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$463.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$715.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$411.32
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$538.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$538.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$538.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$463.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$463.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.60
|
| Rate for Payer: University Health Alliance Commercial |
$502.84
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$6,335.00
|
|
|
Service Code
|
HCPCS 11770
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$5,384.75 |
| Rate for Payer: AlohaCare Medicaid |
$189.25
|
| Rate for Payer: AlohaCare Medicare |
$182.61
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Cash Price |
$4,117.75
|
| Rate for Payer: Devoted Health Medicare |
$182.61
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$189.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$295.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$210.08
|
| Rate for Payer: Health Management Network Commercial |
$5,384.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.61
|
| Rate for Payer: University Health Alliance Commercial |
$204.13
|
|
|
EXC SKIN TAG 1 TO 15 Charge
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
440112000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.50
|
| Rate for Payer: AlohaCare Medicare |
$180.18
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$394.68
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| 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 |
$180.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$407.55
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Humana Medicare |
$180.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.18
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.18
|
| Rate for Payer: University Health Alliance Commercial |
$312.70
|
|
|
EXC SKIN TAG 1 TO 15 Charge
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
440112000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
|
|
exemestane 25 mg Tab [KMC]
|
Facility
|
OP
|
$80.93
|
|
|
Service Code
|
HCPCS S0156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$78.50 |
| Rate for Payer: AlohaCare Medicaid |
$40.47
|
| Rate for Payer: AlohaCare Medicare |
$33.99
|
| Rate for Payer: Cash Price |
$52.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$74.46
|
| Rate for Payer: Devoted Health Medicare |
$33.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.88
|
| Rate for Payer: Health Management Network Commercial |
$68.79
|
| Rate for Payer: Humana Medicare |
$33.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.99
|
| Rate for Payer: MDX Hawaii PPO |
$78.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.99
|
| Rate for Payer: University Health Alliance Commercial |
$58.99
|
|
|
exemestane 25 mg Tab [KMC]
|
Facility
|
IP
|
$80.93
|
|
|
Service Code
|
HCPCS S0156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.79 |
| Max. Negotiated Rate |
$78.50 |
| Rate for Payer: Cash Price |
$52.60
|
| Rate for Payer: Health Management Network Commercial |
$68.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.84
|
| Rate for Payer: MDX Hawaii PPO |
$78.50
|
|
