|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$2,418.00
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$1,296.59 |
| Max. Negotiated Rate |
$2,230.22 |
| Rate for Payer: AlohaCare Medicaid |
$1,418.78
|
| Rate for Payer: AlohaCare Medicare |
$1,296.59
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Devoted Health Medicare |
$1,426.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,296.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,556.10
|
| Rate for Payer: Health Management Network Commercial |
$2,055.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,555.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,555.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,555.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,418.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,418.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.59
|
| Rate for Payer: University Health Alliance Commercial |
$2,230.22
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,593.00
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,924.48 |
| Max. Negotiated Rate |
$3,351.41 |
| Rate for Payer: AlohaCare Medicaid |
$2,104.59
|
| Rate for Payer: AlohaCare Medicare |
$1,924.48
|
| Rate for Payer: Cash Price |
$2,155.80
|
| Rate for Payer: Cash Price |
$2,155.80
|
| Rate for Payer: Devoted Health Medicare |
$2,116.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,924.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,338.44
|
| Rate for Payer: Health Management Network Commercial |
$3,054.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,309.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,309.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,309.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,104.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,924.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,104.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,924.48
|
| Rate for Payer: University Health Alliance Commercial |
$3,351.41
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$2,175.00
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$1,168.13 |
| Max. Negotiated Rate |
$1,848.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,276.71
|
| Rate for Payer: AlohaCare Medicare |
$1,168.13
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Devoted Health Medicare |
$1,284.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,168.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,408.16
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,401.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,401.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,401.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,276.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,168.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,276.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,168.13
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT
|
Professional
|
Both
|
$3,603.00
|
|
|
Service Code
|
HCPCS 34704
|
| Min. Negotiated Rate |
$1,885.61 |
| Max. Negotiated Rate |
$3,062.55 |
| Rate for Payer: AlohaCare Medicaid |
$2,120.87
|
| Rate for Payer: AlohaCare Medicare |
$1,885.61
|
| Rate for Payer: Cash Price |
$2,161.80
|
| Rate for Payer: Cash Price |
$2,161.80
|
| Rate for Payer: Devoted Health Medicare |
$2,074.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,885.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,341.04
|
| Rate for Payer: Health Management Network Commercial |
$3,062.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,262.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,262.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,262.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,120.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,885.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,120.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,885.61
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$2,833.00
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$1,220.51 |
| Max. Negotiated Rate |
$2,408.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,664.06
|
| Rate for Payer: AlohaCare Medicare |
$1,220.51
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Cash Price |
$1,699.80
|
| Rate for Payer: Devoted Health Medicare |
$1,342.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,220.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,807.52
|
| Rate for Payer: Health Management Network Commercial |
$2,408.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,464.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,464.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,464.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,664.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,220.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,664.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,220.51
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$369.80 |
| Max. Negotiated Rate |
$647.67 |
| Rate for Payer: AlohaCare Medicaid |
$406.07
|
| Rate for Payer: AlohaCare Medicare |
$369.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Devoted Health Medicare |
$406.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$451.88
|
| Rate for Payer: Health Management Network Commercial |
$587.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$406.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.80
|
| Rate for Payer: University Health Alliance Commercial |
$647.67
|
|
|
PREVENA DRSG 13CM PRE1155US
|
Facility
|
OP
|
$1,033.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.23 |
| Max. Negotiated Rate |
$1,002.01 |
| Rate for Payer: AlohaCare Medicaid |
$516.50
|
| Rate for Payer: AlohaCare Medicare |
$320.23
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Devoted Health Medicare |
$351.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$320.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$981.35
|
| Rate for Payer: Health Management Network Commercial |
$878.05
|
| Rate for Payer: Humana Medicare |
$320.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$929.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$526.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$320.23
|
| Rate for Payer: MDX Hawaii PPO |
$1,002.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$320.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$320.23
|
| Rate for Payer: University Health Alliance Commercial |
$752.95
|
|
|
PREVENA DRSG 13CM PRE1155US
|
Facility
|
IP
|
$1,033.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.05 |
| Max. Negotiated Rate |
$1,002.01 |
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Health Management Network Commercial |
$878.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$929.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,002.01
|
|
|
PREVENA DRSG 20CM PRE1055US
|
Facility
|
IP
|
$1,057.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.45 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
|
|
PREVENA DRSG 20CM PRE1055US
|
Facility
|
OP
|
$1,057.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: AlohaCare Medicaid |
$528.50
|
| Rate for Payer: AlohaCare Medicare |
$327.67
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Devoted Health Medicare |
$359.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$327.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.15
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Humana Medicare |
$327.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$539.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$327.67
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$327.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$327.67
|
| Rate for Payer: University Health Alliance Commercial |
$770.45
|
|
|
PREVENA PLUS 125 PRE4000US
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 97608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$1,891.50 |
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Health Management Network Commercial |
$1,657.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,755.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,891.50
|
|
|
PREVENA PLUS 125 PRE4000US
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 97608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$975.00
|
| Rate for Payer: AlohaCare Medicare |
$604.50
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Devoted Health Medicare |
$663.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$604.50
|
| Rate for Payer: Health Management Network Commercial |
$1,657.50
|
| Rate for Payer: Humana Medicare |
$604.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$604.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,891.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$604.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$604.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$604.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,421.36
|
|
|
PREVENA PLUS 150ML PRE4095
|
Facility
|
IP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
PREVENA PLUS 150ML PRE4095
|
Facility
|
OP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$104.00
|
| Rate for Payer: AlohaCare Medicare |
$64.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$70.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$64.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.48
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.48
|
| Rate for Payer: University Health Alliance Commercial |
$151.61
|
|
|
PREVENA PLUS DRSG PRE4055US
|
Facility
|
OP
|
$1,327.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.37 |
| Max. Negotiated Rate |
$1,287.19 |
| Rate for Payer: AlohaCare Medicaid |
$663.50
|
| Rate for Payer: AlohaCare Medicare |
$411.37
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Devoted Health Medicare |
$451.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$411.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,260.65
|
| Rate for Payer: Health Management Network Commercial |
$1,127.95
|
| Rate for Payer: Humana Medicare |
$411.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,194.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$676.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$411.37
|
| Rate for Payer: MDX Hawaii PPO |
$1,287.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$411.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$411.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$411.37
|
| Rate for Payer: University Health Alliance Commercial |
$967.25
|
|
|
PREVENA PLUS DRSG PRE4055US
|
Facility
|
IP
|
$1,327.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.95 |
| Max. Negotiated Rate |
$1,287.19 |
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Health Management Network Commercial |
$1,127.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,194.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,287.19
|
|
|
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
|
|
