|
16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
8037312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$58.39
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
| Rate for Payer: University Health Alliance Commercial |
$100.00
|
|
|
16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
8022703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.25 |
| Max. Negotiated Rate |
$586.85 |
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
|
|
16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
8022703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$302.50
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Devoted Health Medicare |
$332.75
|
| 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 |
$302.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.75
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Humana Medicare |
$302.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$302.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.50
|
| Rate for Payer: University Health Alliance Commercial |
$440.98
|
|
|
16025-Burn Dressings/Debridement Medium
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8080214
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$255.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Devoted Health Medicare |
$280.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Humana Medicare |
$255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.00
|
| Rate for Payer: University Health Alliance Commercial |
$371.74
|
|
|
16025-Burn Dressings/Debridement Medium
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8080214
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
|
|
16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM TechFee
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8022704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$302.50
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Devoted Health Medicare |
$332.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$302.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.75
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Humana Medicare |
$302.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$302.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.50
|
| Rate for Payer: University Health Alliance Commercial |
$440.98
|
|
|
16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM TechFee
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
8022704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.25 |
| Max. Negotiated Rate |
$586.85 |
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
|
|
16030-Burn Dressings/Debridement Large
|
Facility
|
IP
|
$2,189.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
8080216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,860.65 |
| Max. Negotiated Rate |
$2,123.33 |
| Rate for Payer: Cash Price |
$1,422.85
|
| Rate for Payer: Health Management Network Commercial |
$1,860.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,970.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,123.33
|
|
|
16030-Burn Dressings/Debridement Large
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
8080216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$525.09 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,094.50
|
| Rate for Payer: Cash Price |
$1,422.85
|
| Rate for Payer: Cash Price |
$1,422.85
|
| Rate for Payer: Cash Price |
$1,422.85
|
| Rate for Payer: Devoted Health Medicare |
$1,203.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,094.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,079.55
|
| Rate for Payer: Health Management Network Commercial |
$1,860.65
|
| Rate for Payer: Humana Medicare |
$1,094.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,970.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,094.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,123.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,094.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,094.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,094.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,595.56
|
|
|
16030 Dressings and/or debridement of partial-thickness burns, initial or subsequent; large
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
8037314
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$132.54
|
| Rate for Payer: AlohaCare Medicare |
$122.45
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$134.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$221.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.45
|
|
|
17250-Chemical Cauterization Granulation Tissue
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
8080218
|
|
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
|
|
|
17250-Chemical Cauterization Granulation Tissue
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
8080218
|
|
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
|
|
|
17-OH Progestrone FSI
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
8117757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: AlohaCare Medicaid |
$99.50
|
| Rate for Payer: AlohaCare Medicare |
$99.50
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$109.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Humana Medicare |
$99.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.50
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$45.27
|
|
|
17-OH Progestrone FSI
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
8117757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$169.15 |
| Max. Negotiated Rate |
$193.03 |
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
19020-Mastotomy Exploration/Drain Abscess Deep
|
Facility
|
IP
|
$8,191.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
8080057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6,962.35 |
| Max. Negotiated Rate |
$7,945.27 |
| Rate for Payer: Cash Price |
$5,324.15
|
| Rate for Payer: Health Management Network Commercial |
$6,962.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,371.90
|
| Rate for Payer: MDX Hawaii PPO |
$7,945.27
|
|
|
19020-Mastotomy Exploration/Drain Abscess Deep
|
Facility
|
OP
|
$8,191.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
8080057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,945.27 |
| Rate for Payer: AlohaCare Medicaid |
$901.48
|
| Rate for Payer: AlohaCare Medicare |
$4,095.50
|
| Rate for Payer: Cash Price |
$5,324.15
|
| Rate for Payer: Cash Price |
$5,324.15
|
| Rate for Payer: Devoted Health Medicare |
$4,505.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,095.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,781.45
|
| Rate for Payer: Health Management Network Commercial |
$6,962.35
|
| Rate for Payer: Humana Medicare |
$4,095.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,371.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,177.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,095.50
|
| Rate for Payer: MDX Hawaii PPO |
$7,945.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,095.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,095.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,095.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
19081 Biopsy, breast, w/ localization device; first lesion, including stereotactic guidance
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
8037344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.01 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$160.43
|
| Rate for Payer: AlohaCare Medicare |
$136.01
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$149.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$160.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$277.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$758.42
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.01
|
| Rate for Payer: University Health Alliance Commercial |
$275.00
|
|
|
19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue
|
Professional
|
Both
|
$1,339.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
8037352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.54 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: AlohaCare Medicaid |
$426.08
|
| Rate for Payer: AlohaCare Medicare |
$410.27
|
| Rate for Payer: Cash Price |
$870.35
|
| Rate for Payer: Cash Price |
$870.35
|
| Rate for Payer: Devoted Health Medicare |
$451.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$426.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$711.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$426.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.54
|
| Rate for Payer: Health Management Network Commercial |
$1,138.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$426.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$426.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.27
|
| Rate for Payer: University Health Alliance Commercial |
$463.91
|
|
|
19300 Mastectomy for gynecomastia
|
Professional
|
Both
|
$5,449.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
8037357
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$437.95 |
| Max. Negotiated Rate |
$4,631.65 |
| Rate for Payer: AlohaCare Medicaid |
$449.29
|
| Rate for Payer: AlohaCare Medicare |
$437.95
|
| Rate for Payer: Cash Price |
$3,541.85
|
| Rate for Payer: Cash Price |
$3,541.85
|
| Rate for Payer: Devoted Health Medicare |
$481.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$449.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$721.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$449.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.16
|
| Rate for Payer: Health Management Network Commercial |
$4,631.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$481.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$481.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$449.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$449.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.95
|
| Rate for Payer: University Health Alliance Commercial |
$491.01
|
|
|
19301 Mastectomy, partial
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
8037358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.44 |
| Max. Negotiated Rate |
$1,649.00 |
| Rate for Payer: AlohaCare Medicaid |
$661.92
|
| Rate for Payer: AlohaCare Medicare |
$626.73
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Devoted Health Medicare |
$689.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.44
|
| Rate for Payer: Health Management Network Commercial |
$1,649.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$689.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$689.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$689.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.73
|
|
|
19303 Mastectomy, simple, complete
|
Professional
|
Both
|
$9,241.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
8037360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$746.98 |
| Max. Negotiated Rate |
$7,854.85 |
| Rate for Payer: AlohaCare Medicaid |
$956.40
|
| Rate for Payer: AlohaCare Medicare |
$904.49
|
| Rate for Payer: Cash Price |
$6,006.65
|
| Rate for Payer: Cash Price |
$6,006.65
|
| Rate for Payer: Devoted Health Medicare |
$994.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$904.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.98
|
| Rate for Payer: Health Management Network Commercial |
$7,854.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$994.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$994.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$994.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$956.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$904.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$956.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$904.49
|
|
|
19304 MASTECTOMY, SUBCUTANEOUS ProFee
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
8016758
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$1,083.75 |
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
|
|
19305 Mastectomy, radical, including pectoral muscles, axillary lymph nodes
|
Professional
|
Both
|
$1,923.00
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
8118452
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,087.08 |
| Max. Negotiated Rate |
$1,634.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,151.79
|
| Rate for Payer: AlohaCare Medicare |
$1,087.08
|
| Rate for Payer: Cash Price |
$1,249.95
|
| Rate for Payer: Cash Price |
$1,249.95
|
| Rate for Payer: Devoted Health Medicare |
$1,195.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,087.08
|
| Rate for Payer: Health Management Network Commercial |
$1,634.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,195.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,195.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,195.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,151.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,087.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,151.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,087.08
|
|
|
1st Psyc Collab Care Mgmt
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99492
|
| Hospital Charge Code |
9763741
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.21 |
| Max. Negotiated Rate |
$173.83 |
| Rate for Payer: AlohaCare Medicaid |
$95.04
|
| Rate for Payer: AlohaCare Medicare |
$82.21
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Devoted Health Medicare |
$90.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$95.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$173.83
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.21
|
| Rate for Payer: University Health Alliance Commercial |
$112.69
|
|
|
1St/Sbsq Psyc Collab Care
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99494
|
| Hospital Charge Code |
9763826
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$71.09 |
| Rate for Payer: AlohaCare Medicaid |
$41.62
|
| Rate for Payer: AlohaCare Medicare |
$36.14
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Devoted Health Medicare |
$39.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.09
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.14
|
| Rate for Payer: University Health Alliance Commercial |
$50.66
|
|
