|
10160-Aspiration Abscess/Cyst/Hematoma
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8080053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$535.00
|
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Devoted Health Medicare |
$588.50
|
| 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 |
$535.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,016.50
|
| Rate for Payer: Health Management Network Commercial |
$909.50
|
| Rate for Payer: Humana Medicare |
$535.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$963.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$535.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,037.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$535.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$535.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$535.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
10160-Aspiration Abscess/Cyst/Hematoma
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8080053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$909.50 |
| Max. Negotiated Rate |
$1,037.90 |
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Health Management Network Commercial |
$909.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$963.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,037.90
|
|
|
10180 Incision and drainage, complex, postoperative wound infection
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
8037073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$198.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8022547
|
|
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 |
$785.00
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Devoted Health Medicare |
$863.50
|
| 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 |
$785.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,491.50
|
| Rate for Payer: Health Management Network Commercial |
$1,334.50
|
| Rate for Payer: Humana Medicare |
$785.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$785.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,522.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$785.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$785.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$785.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,144.37
|
|
|
11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8022547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,334.50 |
| Max. Negotiated Rate |
$1,522.90 |
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Health Management Network Commercial |
$1,334.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,522.90
|
|
|
11000-Extensive Eczematous/Infected Skin Less Than 10%
|
Facility
|
OP
|
$1,376.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8080152
|
|
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 |
$688.00
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Devoted Health Medicare |
$756.80
|
| 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 |
$688.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,307.20
|
| Rate for Payer: Health Management Network Commercial |
$1,169.60
|
| Rate for Payer: Humana Medicare |
$688.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$688.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,334.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$688.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$688.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,002.97
|
|
|
11000-Extensive Eczematous/Infected Skin Less Than 10%
|
Facility
|
IP
|
$1,376.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8080152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,169.60 |
| Max. Negotiated Rate |
$1,334.72 |
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Health Management Network Commercial |
$1,169.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,334.72
|
|
|
11001-Extensive Eczematous/Infected Skin Each Additional 10%
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8080153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.65 |
| Max. Negotiated Rate |
$202.73 |
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Health Management Network Commercial |
$177.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.10
|
| Rate for Payer: MDX Hawaii PPO |
$202.73
|
|
|
11001-Extensive Eczematous/Infected Skin Each Additional 10%
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8080153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$104.50
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Devoted Health Medicare |
$114.95
|
| 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 |
$104.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.55
|
| Rate for Payer: Health Management Network Commercial |
$177.65
|
| Rate for Payer: Humana Medicare |
$104.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.50
|
| Rate for Payer: MDX Hawaii PPO |
$202.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.50
|
| Rate for Payer: University Health Alliance Commercial |
$152.34
|
|
|
11005 Debride of skin, subQ tissue, muscle/fascia for necrotizing soft tissue infection; abd wall
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
8037077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,805.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$725.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$725.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.83
|
| Rate for Payer: University Health Alliance Commercial |
$1,026.00
|
|
|
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8022551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$810.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Devoted Health Medicare |
$891.00
|
| 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 |
$810.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,539.00
|
| Rate for Payer: Health Management Network Commercial |
$1,377.00
|
| Rate for Payer: Humana Medicare |
$810.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,458.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,571.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$810.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$810.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$810.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,180.82
|
|
|
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8022551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.00 |
| Max. Negotiated Rate |
$1,571.40 |
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Health Management Network Commercial |
$1,377.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,458.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,571.40
|
|
|
11010-FB Skin/Subsequent of Open Fracture/Dislocation Site
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8080154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.60 |
| Max. Negotiated Rate |
$1,373.52 |
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Health Management Network Commercial |
$1,203.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,274.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,373.52
|
|
|
11010-FB Skin/Subsequent of Open Fracture/Dislocation Site
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8080154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$708.00
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Devoted Health Medicare |
$778.80
|
| 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 |
$708.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network Commercial |
$1,203.60
|
| Rate for Payer: Humana Medicare |
$708.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,274.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$708.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,373.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$708.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$708.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$708.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,032.12
|
|
|
11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8022554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,297.10 |
| Max. Negotiated Rate |
$1,480.22 |
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Health Management Network Commercial |
$1,297.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,373.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,480.22
|
|
|
11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8022554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$763.00
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Devoted Health Medicare |
$839.30
|
| 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 |
$763.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,449.70
|
| Rate for Payer: Health Management Network Commercial |
$1,297.10
|
| Rate for Payer: Humana Medicare |
$763.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,373.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$763.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,480.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$763.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$763.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
11042 Debridement, subcutaneous tissue; first 20 sq cm or less
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8037083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$61.67
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| 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 |
$61.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
|
|
11042-SQ Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8080155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.15 |
| Max. Negotiated Rate |
$891.43 |
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$827.10
|
| Rate for Payer: MDX Hawaii PPO |
$891.43
|
|
|
11042-SQ Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8080155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$459.50
|
| Rate for Payer: AlohaCare Medicare |
$459.50
|
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Devoted Health Medicare |
$505.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$459.50
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Humana Medicare |
$459.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$827.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$459.50
|
| Rate for Payer: MDX Hawaii PPO |
$891.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$459.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$459.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
11043 Debridement, muscle and/or fascia; first 20 sq cm or less
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
8037084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$153.95
|
| Rate for Payer: AlohaCare Medicare |
$137.36
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$151.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$340.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.22
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.36
|
|
|
11043-SQ Tissue/Muscle Less Than/Equal to 1st 20 sq cm
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
8080156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,054.00
|
| Rate for Payer: AlohaCare Medicare |
$1,054.00
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Devoted Health Medicare |
$1,159.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,054.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Health Management Network Commercial |
$1,791.80
|
| Rate for Payer: Humana Medicare |
$1,054.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,897.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,054.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,044.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,054.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,054.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,054.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
11043-SQ Tissue/Muscle Less Than/Equal to 1st 20 sq cm
|
Facility
|
IP
|
$2,108.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
8080156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,791.80 |
| Max. Negotiated Rate |
$2,044.76 |
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Health Management Network Commercial |
$1,791.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,897.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,044.76
|
|
|
11044 Debridement, bone; first 20 sq cm or less
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
8037085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.39 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$223.77
|
| Rate for Payer: AlohaCare Medicare |
$198.39
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$218.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$223.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$461.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$223.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.52
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.39
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
11045 Debridement, subcutaneous tissue each additional 20 sq cm, or part thereof
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
8037086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: AlohaCare Medicaid |
$24.64
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.64
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$30.72
|
|
|
11046 Debridement, muscle and/or fascia; each additional 20 sq cm, or part thereof
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
8037087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$131.75 |
| Rate for Payer: AlohaCare Medicaid |
$53.52
|
| Rate for Payer: AlohaCare Medicare |
$46.19
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Devoted Health Medicare |
$50.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$85.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.52
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.19
|
| Rate for Payer: University Health Alliance Commercial |
$62.70
|
|
