|
PR EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 25112
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: AlohaCare Medicaid |
$419.72
|
| Rate for Payer: AlohaCare Medicare |
$391.54
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Devoted Health Medicare |
$430.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$391.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$614.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$469.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$469.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$419.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$391.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$419.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$391.54
|
|
|
PR EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$869.84
|
|
|
Service Code
|
HCPCS 11450
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$739.36 |
| Rate for Payer: AlohaCare Medicaid |
$273.23
|
| Rate for Payer: AlohaCare Medicare |
$261.98
|
| Rate for Payer: Cash Price |
$521.90
|
| Rate for Payer: Cash Price |
$521.90
|
| Rate for Payer: Devoted Health Medicare |
$288.18
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$273.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.64
|
| Rate for Payer: Health Management Network Commercial |
$739.36
|
| 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
|
|
|
PR EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR
|
Professional
|
Both
|
$850.20
|
|
|
Service Code
|
HCPCS 11462
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$722.67 |
| Rate for Payer: AlohaCare Medicaid |
$260.96
|
| Rate for Payer: AlohaCare Medicare |
$250.76
|
| Rate for Payer: Cash Price |
$510.12
|
| Rate for Payer: Cash Price |
$510.12
|
| Rate for Payer: Devoted Health Medicare |
$275.84
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$260.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$722.67
|
| 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
|
|
|
PR EXCISION H/P/P/U COMPLEX REPAIR
|
Professional
|
Both
|
$1,096.83
|
|
|
Service Code
|
HCPCS 11471
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$932.31 |
| Rate for Payer: AlohaCare Medicaid |
$364.12
|
| Rate for Payer: AlohaCare Medicare |
$338.14
|
| Rate for Payer: Cash Price |
$658.10
|
| Rate for Payer: Cash Price |
$658.10
|
| Rate for Payer: Devoted Health Medicare |
$371.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$364.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$560.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$364.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$220.48
|
| Rate for Payer: Health Management Network Commercial |
$932.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$364.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.14
|
| Rate for Payer: University Health Alliance Commercial |
$414.97
|
|
|
PR EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$942.57
|
|
|
Service Code
|
HCPCS 11470
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$801.18 |
| Rate for Payer: AlohaCare Medicaid |
$298.17
|
| Rate for Payer: AlohaCare Medicare |
$287.96
|
| Rate for Payer: Cash Price |
$565.54
|
| Rate for Payer: Cash Price |
$565.54
|
| Rate for Payer: Devoted Health Medicare |
$316.76
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$298.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$801.18
|
| 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
|
|
|
PR EXCISION HYDROCELE BILATERAL
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 55041
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$764.15 |
| Rate for Payer: AlohaCare Medicaid |
$525.13
|
| Rate for Payer: AlohaCare Medicare |
$476.85
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Devoted Health Medicare |
$524.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$433.16
|
| Rate for Payer: Health Management Network Commercial |
$764.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$572.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$572.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.85
|
|
|
PR EXCISION HYDROCELE UNILATERAL
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 55040
|
| Min. Negotiated Rate |
$320.59 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: AlohaCare Medicaid |
$349.77
|
| Rate for Payer: AlohaCare Medicare |
$320.59
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Devoted Health Medicare |
$352.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$320.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$386.62
|
| Rate for Payer: Health Management Network Commercial |
$509.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$384.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$384.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$384.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$320.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$349.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$320.59
|
| Rate for Payer: University Health Alliance Commercial |
$453.99
|
|
|
PR EXCISION INFECTED GRAFT ABDOMEN
|
Professional
|
Both
|
$3,025.00
|
|
|
Service Code
|
HCPCS 35907
|
| Min. Negotiated Rate |
$795.86 |
| Max. Negotiated Rate |
$2,571.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,770.57
|
| Rate for Payer: AlohaCare Medicare |
$1,620.72
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Devoted Health Medicare |
$1,782.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,620.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$795.86
|
| Rate for Payer: Health Management Network Commercial |
$2,571.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,944.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,944.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,944.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,770.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,620.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,770.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,620.72
|
|
|
PR EXCISION INFECTED GRAFT EXTREMITY
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 35903
|
| Min. Negotiated Rate |
$502.34 |
| Max. Negotiated Rate |
$783.70 |
| Rate for Payer: AlohaCare Medicaid |
$542.98
|
| Rate for Payer: AlohaCare Medicare |
$502.34
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Devoted Health Medicare |
$552.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$502.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.52
|
| Rate for Payer: Health Management Network Commercial |
$783.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$602.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$602.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$602.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$542.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$502.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$542.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$502.34
|
|
|
PR EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 30130
|
| Min. Negotiated Rate |
$215.54 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: AlohaCare Medicaid |
$455.12
|
| Rate for Payer: AlohaCare Medicare |
$422.57
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Devoted Health Medicare |
$464.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$422.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$215.54
|
| Rate for Payer: Health Management Network Commercial |
$652.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$507.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$455.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$422.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$455.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$422.57
|
|
|
PR EXCISION LACTIFEROUS DUCT FISTULA
|
Professional
|
Both
|
$944.21
|
|
|
Service Code
|
HCPCS 19112
|
| Min. Negotiated Rate |
$278.46 |
| Max. Negotiated Rate |
$802.58 |
| Rate for Payer: AlohaCare Medicaid |
$337.51
|
| Rate for Payer: AlohaCare Medicare |
$340.55
|
| Rate for Payer: Cash Price |
$566.53
|
| Rate for Payer: Cash Price |
$566.53
|
| Rate for Payer: Devoted Health Medicare |
$374.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$337.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$511.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$340.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$337.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.46
|
| Rate for Payer: Health Management Network Commercial |
$802.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$408.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$408.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$337.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$340.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$337.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$340.55
|
| Rate for Payer: University Health Alliance Commercial |
$386.27
|
|
|
PR EXCISION LESION FLOOR MOUTH
|
Professional
|
Both
|
$636.48
|
|
|
Service Code
|
HCPCS 41116
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$541.01 |
| Rate for Payer: AlohaCare Medicaid |
$230.98
|
| Rate for Payer: AlohaCare Medicare |
$211.03
|
| Rate for Payer: Cash Price |
$381.89
|
| Rate for Payer: Cash Price |
$381.89
|
| Rate for Payer: Devoted Health Medicare |
$232.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$230.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$230.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.54
|
| Rate for Payer: Health Management Network Commercial |
$541.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$253.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$253.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$253.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$230.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.03
|
| Rate for Payer: University Health Alliance Commercial |
$298.18
|
|
|
PR EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 27347
|
| Min. Negotiated Rate |
$437.32 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: AlohaCare Medicaid |
$557.70
|
| Rate for Payer: AlohaCare Medicare |
$522.63
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Devoted Health Medicare |
$574.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.32
|
| Rate for Payer: Health Management Network Commercial |
$814.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$557.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$557.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.63
|
|
|
PR EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,067.06
|
|
|
Service Code
|
HCPCS 27630
|
| Min. Negotiated Rate |
$268.58 |
| Max. Negotiated Rate |
$907.00 |
| Rate for Payer: AlohaCare Medicaid |
$377.73
|
| Rate for Payer: AlohaCare Medicare |
$358.72
|
| Rate for Payer: Cash Price |
$640.24
|
| Rate for Payer: Cash Price |
$640.24
|
| Rate for Payer: Devoted Health Medicare |
$394.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$377.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$579.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$358.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$377.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.58
|
| Rate for Payer: Health Management Network Commercial |
$907.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$430.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$377.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.72
|
| Rate for Payer: University Health Alliance Commercial |
$473.24
|
|
|
PR EXCISION LESION TENDON SHEATH FOREARM&/WRIST
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 25110
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$544.85 |
| Rate for Payer: AlohaCare Medicaid |
$372.61
|
| Rate for Payer: AlohaCare Medicare |
$351.38
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Devoted Health Medicare |
$386.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$351.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$421.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$421.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$351.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$372.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$351.38
|
|
|
PR EXCISION LESION TONGUE W/O CLOSURE
|
Professional
|
Both
|
$432.23
|
|
|
Service Code
|
HCPCS 41110
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$367.40 |
| Rate for Payer: AlohaCare Medicaid |
$138.27
|
| Rate for Payer: AlohaCare Medicare |
$124.33
|
| Rate for Payer: Cash Price |
$259.34
|
| Rate for Payer: Cash Price |
$259.34
|
| Rate for Payer: Devoted Health Medicare |
$136.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.68
|
| Rate for Payer: Health Management Network Commercial |
$367.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.33
|
| Rate for Payer: University Health Alliance Commercial |
$180.90
|
|
|
PR EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$486.92
|
|
|
Service Code
|
HCPCS 41115
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$413.88 |
| Rate for Payer: AlohaCare Medicaid |
$155.28
|
| Rate for Payer: AlohaCare Medicare |
$138.86
|
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Devoted Health Medicare |
$152.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$155.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.94
|
| Rate for Payer: Health Management Network Commercial |
$413.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.86
|
| Rate for Payer: University Health Alliance Commercial |
$201.92
|
|
|
PR EXCISION LOCAL LESION EPIDIDYMIS
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 54830
|
| Min. Negotiated Rate |
$259.22 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: AlohaCare Medicaid |
$385.22
|
| Rate for Payer: AlohaCare Medicare |
$353.99
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Devoted Health Medicare |
$389.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$353.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.22
|
| Rate for Payer: Health Management Network Commercial |
$561.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$424.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$424.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$424.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$353.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$385.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$353.99
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$383.16
|
|
|
Service Code
|
HCPCS 11640
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$325.69 |
| Rate for Payer: AlohaCare Medicaid |
$133.33
|
| Rate for Payer: AlohaCare Medicare |
$114.90
|
| Rate for Payer: Cash Price |
$229.90
|
| Rate for Payer: Cash Price |
$229.90
|
| Rate for Payer: Devoted Health Medicare |
$126.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$202.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$325.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.90
|
| Rate for Payer: University Health Alliance Commercial |
$150.15
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$446.41
|
|
|
Service Code
|
HCPCS 11641
|
| Min. Negotiated Rate |
$138.50 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: AlohaCare Medicaid |
$162.19
|
| Rate for Payer: AlohaCare Medicare |
$138.50
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Devoted Health Medicare |
$152.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$180.44
|
| Rate for Payer: Health Management Network Commercial |
$379.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$166.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$162.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.50
|
| Rate for Payer: University Health Alliance Commercial |
$183.32
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$500.80
|
|
|
Service Code
|
HCPCS 11642
|
| Min. Negotiated Rate |
$158.57 |
| Max. Negotiated Rate |
$425.68 |
| Rate for Payer: AlohaCare Medicaid |
$188.80
|
| Rate for Payer: AlohaCare Medicare |
$158.57
|
| Rate for Payer: Cash Price |
$300.48
|
| Rate for Payer: Cash Price |
$300.48
|
| Rate for Payer: Devoted Health Medicare |
$174.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$188.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$289.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$188.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.46
|
| Rate for Payer: Health Management Network Commercial |
$425.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$188.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.57
|
| Rate for Payer: University Health Alliance Commercial |
$214.00
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$588.02
|
|
|
Service Code
|
HCPCS 11643
|
| Min. Negotiated Rate |
$196.63 |
| Max. Negotiated Rate |
$499.82 |
| Rate for Payer: AlohaCare Medicaid |
$233.73
|
| Rate for Payer: AlohaCare Medicare |
$196.63
|
| Rate for Payer: Cash Price |
$352.81
|
| Rate for Payer: Cash Price |
$352.81
|
| Rate for Payer: Devoted Health Medicare |
$216.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$233.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$359.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$233.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$251.68
|
| Rate for Payer: Health Management Network Commercial |
$499.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$235.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$235.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$233.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.63
|
| Rate for Payer: University Health Alliance Commercial |
$266.33
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$727.79
|
|
|
Service Code
|
HCPCS 11644
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$618.62 |
| Rate for Payer: AlohaCare Medicaid |
$288.00
|
| Rate for Payer: AlohaCare Medicare |
$242.32
|
| Rate for Payer: Cash Price |
$436.67
|
| Rate for Payer: Cash Price |
$436.67
|
| Rate for Payer: Devoted Health Medicare |
$266.55
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$288.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$236.60
|
| Rate for Payer: Health Management Network Commercial |
$618.62
|
| 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
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$945.30
|
|
|
Service Code
|
HCPCS 11646
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$803.50 |
| Rate for Payer: AlohaCare Medicaid |
$393.63
|
| Rate for Payer: AlohaCare Medicare |
$333.01
|
| Rate for Payer: Cash Price |
$567.18
|
| Rate for Payer: Cash Price |
$567.18
|
| Rate for Payer: Devoted Health Medicare |
$366.31
|
| Rate for Payer: Hawaii Medical Service Association 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 Medical Service Association Non-ABD |
$393.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.80
|
| Rate for Payer: Health Management Network Commercial |
$803.50
|
| 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
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$375.78
|
|
|
Service Code
|
HCPCS 11620
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$319.41 |
| Rate for Payer: AlohaCare Medicaid |
$129.26
|
| Rate for Payer: AlohaCare Medicare |
$112.95
|
| Rate for Payer: Cash Price |
$225.47
|
| Rate for Payer: Cash Price |
$225.47
|
| Rate for Payer: Devoted Health Medicare |
$124.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$129.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$197.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.46
|
| Rate for Payer: Health Management Network Commercial |
$319.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$135.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.95
|
| Rate for Payer: University Health Alliance Commercial |
$140.05
|
|
