Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

12036-Scalp/Trunk/Extremity 20.1-30.0 cm

Facility

$3,028.00

Service Code	HCPCS 12036
Hospital Charge Code	8080014
Hospital Revenue Code	450
Min. Negotiated Rate	$2,573.80
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: MDX Hawaii PPO	$2,937.16

12036-Scalp/Trunk/Extremity 20.1-30.0 cm

Facility

$3,028.00

Service Code	HCPCS 12036
Hospital Charge Code	8080014
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,937.16
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,514.00
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Devoted Health Medicare	$1,665.40
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	$1,514.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,876.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Humana Medicare	$1,514.00
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,514.00
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: Ohana Health Plan Medicaid	$1,514.00
Rate for Payer: Ohana Health Plan Medicare	$1,514.00
Rate for Payer: UnitedHealthcare Medicare	$1,514.00
Rate for Payer: University Health Alliance Commercial	$2,207.11

12037-Scalp/Trunk/Extremity Greater Than 30.0 cm

Facility

$8,091.00

Service Code	HCPCS 12037
Hospital Charge Code	8080016
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,848.27
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$4,045.50
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Devoted Health Medicare	$4,450.05
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	$4,045.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,686.45
Rate for Payer: Health Management Network Commercial	$6,877.35
Rate for Payer: Humana Medicare	$4,045.50
Rate for Payer: Kaiser Permanente Commercial	$7,281.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,045.50
Rate for Payer: MDX Hawaii PPO	$7,848.27
Rate for Payer: Ohana Health Plan Medicaid	$4,045.50
Rate for Payer: Ohana Health Plan Medicare	$4,045.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,045.50
Rate for Payer: University Health Alliance Commercial	$5,897.53

12037-Scalp/Trunk/Extremity Greater Than 30.0 cm

Facility

$8,091.00

Service Code	HCPCS 12037
Hospital Charge Code	8080016
Hospital Revenue Code	450
Min. Negotiated Rate	$6,877.35
Max. Negotiated Rate	$7,848.27
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Health Management Network Commercial	$6,877.35
Rate for Payer: Kaiser Permanente Commercial	$7,281.90
Rate for Payer: MDX Hawaii PPO	$7,848.27

12041-Neck/Hand/Feet/Genital Less Than/Equal to 2.5 cm

Facility

$810.00

Service Code	HCPCS 12041
Hospital Charge Code	8080018
Hospital Revenue Code	450
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: MDX Hawaii PPO	$785.70

12041-Neck/Hand/Feet/Genital Less Than/Equal to 2.5 cm

Facility

$810.00

Service Code	HCPCS 12041
Hospital Charge Code	8080018
Hospital Revenue Code	450
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$405.00
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$445.50
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	$405.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$769.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$405.00
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$405.00
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$405.00
Rate for Payer: Ohana Health Plan Medicare	$405.00
Rate for Payer: UnitedHealthcare Medicare	$405.00
Rate for Payer: University Health Alliance Commercial	$590.41

12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee

Facility

$880.00

Service Code	HCPCS 12041
Hospital Charge Code	8022645
Hospital Revenue Code	450
Min. Negotiated Rate	$440.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$440.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Devoted Health Medicare	$484.00
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	$440.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$836.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Humana Medicare	$440.00
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$440.00
Rate for Payer: MDX Hawaii PPO	$853.60
Rate for Payer: Ohana Health Plan Medicaid	$440.00
Rate for Payer: Ohana Health Plan Medicare	$440.00
Rate for Payer: UnitedHealthcare Medicare	$440.00
Rate for Payer: University Health Alliance Commercial	$641.43

12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee

Facility

$880.00

Service Code	HCPCS 12041
Hospital Charge Code	8022645
Hospital Revenue Code	450
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$853.60
Rate for Payer: Cash Price	$572.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: MDX Hawaii PPO	$853.60

12042-Neck/Hand/Feet/Genital 2.6-7.5 cm

Facility

$594.00

Service Code	HCPCS 12042
Hospital Charge Code	8080020
Hospital Revenue Code	450
Min. Negotiated Rate	$504.90
Max. Negotiated Rate	$576.18
Rate for Payer: Cash Price	$386.10
Rate for Payer: Health Management Network Commercial	$504.90
Rate for Payer: Kaiser Permanente Commercial	$534.60
Rate for Payer: MDX Hawaii PPO	$576.18

12042-Neck/Hand/Feet/Genital 2.6-7.5 cm

Facility

$594.00

Service Code	HCPCS 12042
Hospital Charge Code	8080020
Hospital Revenue Code	450
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$297.00
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Devoted Health Medicare	$326.70
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	$297.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$564.30
Rate for Payer: Health Management Network Commercial	$504.90
Rate for Payer: Humana Medicare	$297.00
Rate for Payer: Kaiser Permanente Commercial	$534.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$297.00
Rate for Payer: MDX Hawaii PPO	$576.18
Rate for Payer: Ohana Health Plan Medicaid	$297.00
Rate for Payer: Ohana Health Plan Medicare	$297.00
Rate for Payer: UnitedHealthcare Medicare	$297.00
Rate for Payer: University Health Alliance Commercial	$432.97

12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee

Facility

$880.00

Service Code	HCPCS 12042
Hospital Charge Code	8022646
Hospital Revenue Code	450
Min. Negotiated Rate	$440.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$440.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Devoted Health Medicare	$484.00
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	$440.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$836.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Humana Medicare	$440.00
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$440.00
Rate for Payer: MDX Hawaii PPO	$853.60
Rate for Payer: Ohana Health Plan Medicaid	$440.00
Rate for Payer: Ohana Health Plan Medicare	$440.00
Rate for Payer: UnitedHealthcare Medicare	$440.00
Rate for Payer: University Health Alliance Commercial	$641.43

12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee

Facility

$880.00

Service Code	HCPCS 12042
Hospital Charge Code	8022646
Hospital Revenue Code	450
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$853.60
Rate for Payer: Cash Price	$572.00
Rate for Payer: Health Management Network Commercial	$748.00
Rate for Payer: Kaiser Permanente Commercial	$792.00
Rate for Payer: MDX Hawaii PPO	$853.60

12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6-7.5cm

Professional

Both

$1,056.00

Service Code	HCPCS 12042
Hospital Charge Code	8037198
Hospital Revenue Code	975
Min. Negotiated Rate	$159.64
Max. Negotiated Rate	$897.60
Rate for Payer: AlohaCare Medicaid	$203.83
Rate for Payer: AlohaCare Medicare	$173.37
Rate for Payer: Cash Price	$686.40
Rate for Payer: Cash Price	$686.40
Rate for Payer: Devoted Health Medicare	$190.71
Rate for Payer: Hawaii Medical Service Association ABD	$203.83
Rate for Payer: Hawaii Medical Service Association Commercial	$335.13
Rate for Payer: Hawaii Medical Service Association Medicare	$173.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$203.83
Rate for Payer: Hawaii Western Management Group Commercial	$159.64
Rate for Payer: Health Management Network Commercial	$897.60
Rate for Payer: Kaiser Permanente Commercial	$190.71
Rate for Payer: Kaiser Permanente Medicaid	$190.71
Rate for Payer: Kaiser Permanente Medicare	$190.71
Rate for Payer: Ohana Health Plan Medicaid	$203.83
Rate for Payer: Ohana Health Plan Medicare	$173.37
Rate for Payer: UnitedHealthcare Medicaid	$203.83
Rate for Payer: UnitedHealthcare Medicare	$173.37
Rate for Payer: University Health Alliance Commercial	$221.92

12044-Neck/Hand/Feet/Genital 7.6-12.5 cm

Facility

$1,500.00

Service Code	HCPCS 12044
Hospital Charge Code	8080022
Hospital Revenue Code	450
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: MDX Hawaii PPO	$1,455.00

12044-Neck/Hand/Feet/Genital 7.6-12.5 cm

Facility

$1,500.00

Service Code	HCPCS 12044
Hospital Charge Code	8080022
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	$750.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Devoted Health Medicare	$825.00
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	$750.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$750.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$750.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$750.00
Rate for Payer: Ohana Health Plan Medicare	$750.00
Rate for Payer: UnitedHealthcare Medicare	$750.00
Rate for Payer: University Health Alliance Commercial	$1,093.35

12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee

Facility

$1,737.00

Service Code	HCPCS 12044
Hospital Charge Code	8022647
Hospital Revenue Code	450
Min. Negotiated Rate	$1,476.45
Max. Negotiated Rate	$1,684.89
Rate for Payer: Cash Price	$1,129.05
Rate for Payer: Health Management Network Commercial	$1,476.45
Rate for Payer: Kaiser Permanente Commercial	$1,563.30
Rate for Payer: MDX Hawaii PPO	$1,684.89

12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee

Facility

$1,737.00

Service Code	HCPCS 12044
Hospital Charge Code	8022647
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,684.89
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$868.50
Rate for Payer: Cash Price	$1,129.05
Rate for Payer: Cash Price	$1,129.05
Rate for Payer: Cash Price	$1,129.05
Rate for Payer: Devoted Health Medicare	$955.35
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	$868.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,650.15
Rate for Payer: Health Management Network Commercial	$1,476.45
Rate for Payer: Humana Medicare	$868.50
Rate for Payer: Kaiser Permanente Commercial	$1,563.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$868.50
Rate for Payer: MDX Hawaii PPO	$1,684.89
Rate for Payer: Ohana Health Plan Medicaid	$868.50
Rate for Payer: Ohana Health Plan Medicare	$868.50
Rate for Payer: UnitedHealthcare Medicare	$868.50
Rate for Payer: University Health Alliance Commercial	$1,266.10

12045-Neck/Hand/Feet/Genital 12.6-20.0 cm

Facility

$3,028.00

Service Code	HCPCS 12045
Hospital Charge Code	8080024
Hospital Revenue Code	450
Min. Negotiated Rate	$2,573.80
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: MDX Hawaii PPO	$2,937.16

12045-Neck/Hand/Feet/Genital 12.6-20.0 cm

Facility

$3,028.00

Service Code	HCPCS 12045
Hospital Charge Code	8080024
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,937.16
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,514.00
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Devoted Health Medicare	$1,665.40
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	$1,514.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,876.60
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Humana Medicare	$1,514.00
Rate for Payer: Kaiser Permanente Commercial	$2,725.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,514.00
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: Ohana Health Plan Medicaid	$1,514.00
Rate for Payer: Ohana Health Plan Medicare	$1,514.00
Rate for Payer: UnitedHealthcare Medicare	$1,514.00
Rate for Payer: University Health Alliance Commercial	$2,207.11

12046-Neck/Hand/Feet/Genital 20.1-30.0 cm

Facility

$1,984.00

Service Code	HCPCS 12046
Hospital Charge Code	8080007
Hospital Revenue Code	450
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: MDX Hawaii PPO	$1,924.48

12046-Neck/Hand/Feet/Genital 20.1-30.0 cm

Facility

$1,984.00

Service Code	HCPCS 12046
Hospital Charge Code	8080007
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$1,924.48
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$992.00
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Devoted Health Medicare	$1,091.20
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	$992.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$992.00
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$992.00
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$992.00
Rate for Payer: Ohana Health Plan Medicare	$992.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$992.00
Rate for Payer: University Health Alliance Commercial	$1,446.14

12047-Neck/Hand/Feet/Genital Greater Than 30.0 cm

Facility

$8,091.00

Service Code	HCPCS 12047
Hospital Charge Code	8080009
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,848.27
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$4,045.50
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Devoted Health Medicare	$4,450.05
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	$4,045.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,686.45
Rate for Payer: Health Management Network Commercial	$6,877.35
Rate for Payer: Humana Medicare	$4,045.50
Rate for Payer: Kaiser Permanente Commercial	$7,281.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,045.50
Rate for Payer: MDX Hawaii PPO	$7,848.27
Rate for Payer: Ohana Health Plan Medicaid	$4,045.50
Rate for Payer: Ohana Health Plan Medicare	$4,045.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,045.50
Rate for Payer: University Health Alliance Commercial	$5,897.53

12047-Neck/Hand/Feet/Genital Greater Than 30.0 cm

Facility

$8,091.00

Service Code	HCPCS 12047
Hospital Charge Code	8080009
Hospital Revenue Code	450
Min. Negotiated Rate	$6,877.35
Max. Negotiated Rate	$7,848.27
Rate for Payer: Cash Price	$5,259.15
Rate for Payer: Health Management Network Commercial	$6,877.35
Rate for Payer: Kaiser Permanente Commercial	$7,281.90
Rate for Payer: MDX Hawaii PPO	$7,848.27

12051-Face/Ear/Eye/Nose/Lip Less Than/Equal to 2.5 cm

Facility

$810.00

Service Code	HCPCS 12051
Hospital Charge Code	8080011
Hospital Revenue Code	450
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: MDX Hawaii PPO	$785.70

12051-Face/Ear/Eye/Nose/Lip Less Than/Equal to 2.5 cm

Facility

$810.00

Service Code	HCPCS 12051
Hospital Charge Code	8080011
Hospital Revenue Code	450
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$405.00
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$445.50
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	$405.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$769.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$405.00
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$405.00
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$405.00
Rate for Payer: Ohana Health Plan Medicare	$405.00
Rate for Payer: UnitedHealthcare Medicare	$405.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges