|
11055-Paring/Cut Lesion Benign Single
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
8080182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.05 |
| Max. Negotiated Rate |
$1,099.01 |
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
|
|
11055-Paring/Cut Lesion Benign Single
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
8080182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$566.50
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Devoted Health Medicare |
$623.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,076.35
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Humana Medicare |
$566.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$566.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.50
|
| Rate for Payer: University Health Alliance Commercial |
$825.84
|
|
|
11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
8271319
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: AlohaCare Medicaid |
$38.19
|
| Rate for Payer: AlohaCare Medicare |
$30.13
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Devoted Health Medicare |
$33.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.50
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.13
|
| Rate for Payer: University Health Alliance Commercial |
$43.67
|
|
|
11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesi
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
8271325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$56.70
|
| Rate for Payer: AlohaCare Medicare |
$46.07
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$50.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$167.96
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.07
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
8037094
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: AlohaCare Medicaid |
$82.52
|
| Rate for Payer: AlohaCare Medicare |
$73.46
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Devoted Health Medicare |
$80.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$260.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.46
|
| Rate for Payer: University Health Alliance Commercial |
$90.04
|
|
|
11200-Removal Skin Tag up to 15
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
8080184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$566.50
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Devoted Health Medicare |
$623.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,076.35
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Humana Medicare |
$566.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$566.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.50
|
| Rate for Payer: University Health Alliance Commercial |
$825.84
|
|
|
11200-Removal Skin Tag up to 15
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
8080184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.05 |
| Max. Negotiated Rate |
$1,099.01 |
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
|
|
11305-Shave Lesion Scalp/Hand/Feet/Genital <= 0.5 cm
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
8080186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$566.50
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Devoted Health Medicare |
$623.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,076.35
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Humana Medicare |
$566.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$566.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.50
|
| Rate for Payer: University Health Alliance Commercial |
$825.84
|
|
|
11305-Shave Lesion Scalp/Hand/Feet/Genital <= 0.5 cm
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
8080186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.05 |
| Max. Negotiated Rate |
$1,099.01 |
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
|
|
11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
8037108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AlohaCare Medicaid |
$90.72
|
| Rate for Payer: AlohaCare Medicare |
$80.89
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Devoted Health Medicare |
$88.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$90.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.42
|
| Rate for Payer: Health Management Network Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.98
|
| 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
|
|
|
11400-Excision Lesion Benign Trunk/Extremity <= 0.5 cm
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
8080188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
11400-Excision Lesion Benign Trunk/Extremity <= 0.5 cm
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
8080188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
11401 Excision, benign lesion including margins; trunk, arms or legs; 0.6-1.0cm
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
8037109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$472.60 |
| Rate for Payer: AlohaCare Medicaid |
$112.53
|
| Rate for Payer: AlohaCare Medicare |
$98.77
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Devoted Health Medicare |
$108.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$112.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$183.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.66
|
| Rate for Payer: Health Management Network Commercial |
$472.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.77
|
| Rate for Payer: University Health Alliance Commercial |
$122.20
|
|
|
11402 Excision, benign lesion including margins; trunk, arms or legs; 1.1-2.0cm
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
8037110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: AlohaCare Medicaid |
$122.57
|
| Rate for Payer: AlohaCare Medicare |
$106.78
|
| Rate for Payer: Cash Price |
$401.70
|
| Rate for Payer: Cash Price |
$401.70
|
| Rate for Payer: Devoted Health Medicare |
$117.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$200.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.12
|
| Rate for Payer: Health Management Network Commercial |
$525.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.78
|
| Rate for Payer: University Health Alliance Commercial |
$133.24
|
|
|
11402-Excision Lesion Benign Trunk/Extremity 1.1-2.0 cm
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
8080190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
11402-Excision Lesion Benign Trunk/Extremity 1.1-2.0 cm
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
8080190
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
11403 Excision, benign lesion including margins; trunk, arms or legs; 2.1-3.0cm
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
8037111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: AlohaCare Medicaid |
$158.47
|
| Rate for Payer: AlohaCare Medicare |
$141.34
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$155.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$257.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.58
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.47
|
| 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
|
|
|
11406 Excision, benign lesion including margins; trunk, arms or legs; >4.0cm
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
8037113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$256.10
|
| Rate for Payer: AlohaCare Medicare |
$231.38
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$254.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$423.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.52
|
| 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
|
|
|
11420-Excise Lesion BN Scalp/Nose/Hand/Feet/Genital <=0.5 cm
|
Facility
|
OP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
8080192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$3,624.50
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Devoted Health Medicare |
$3,986.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,624.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,886.55
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Humana Medicare |
$3,624.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,624.50
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,624.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,624.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,624.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
11420-Excise Lesion BN Scalp/Nose/Hand/Feet/Genital <=0.5 cm
|
Facility
|
IP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
8080192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,161.65 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
|
|
11424 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 3.1-4.0cm
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
8037118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$189.29
|
| Rate for Payer: AlohaCare Medicare |
$169.64
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| 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 |
$304.76
|
| 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 |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.60
|
| 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
|
|
|
11426 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; > 4.0cm
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
8037119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$275.66
|
| Rate for Payer: AlohaCare Medicare |
$248.18
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$273.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$275.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$462.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$275.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.00
|
| 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
|
|
|
11440-Excise Lesion Benign Face Less Than/Equal to 0.5 cm
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
8080194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,642.26
|
|
|
11440-Excise Lesion Benign Face Less Than/Equal to 0.5 cm
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
8080194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
11441 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 0.6-1.0cm
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
8037121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$532.10 |
| Rate for Payer: AlohaCare Medicaid |
$142.63
|
| Rate for Payer: AlohaCare Medicare |
$126.36
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Cash Price |
$406.90
|
| Rate for Payer: Devoted Health Medicare |
$139.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.34
|
| Rate for Payer: Health Management Network Commercial |
$532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.00
|
| 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
|
|
