|
11721-Nails 6 or More
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
8080158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$19.25
|
| 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 |
$17.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.25
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Humana Medicare |
$17.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.50
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.51
|
|
|
11721-Nails 6 or More
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
8080158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
|
|
11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8022610
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8022610
|
|
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
|
|
|
11730-Avulsion Nail Plate Single
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8080198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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 |
$4,035.20
|
|
|
11730-Avulsion Nail Plate Single
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8080198
|
|
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
|
|
|
11730 Avulsion of nail plate, partial or complete, simple; single
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
8037152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.29 |
| Max. Negotiated Rate |
$245.65 |
| Rate for Payer: AlohaCare Medicaid |
$54.23
|
| Rate for Payer: AlohaCare Medicare |
$49.29
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Devoted Health Medicare |
$54.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.18
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.29
|
| Rate for Payer: University Health Alliance Commercial |
$59.12
|
|
|
11732-Avulsion Nail Plate Each Addl
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
8080200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$106.50
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Devoted Health Medicare |
$117.15
|
| 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 |
$106.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.35
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Humana Medicare |
$106.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.50
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.50
|
| Rate for Payer: University Health Alliance Commercial |
$155.26
|
|
|
11732-Avulsion Nail Plate Each Addl
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
8080200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.05 |
| Max. Negotiated Rate |
$206.61 |
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.70
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
|
|
11740 Evacuation of subungual hematoma
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8037154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: AlohaCare Medicaid |
$34.68
|
| Rate for Payer: AlohaCare Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$36.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$54.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$34.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.49
|
| Rate for Payer: University Health Alliance Commercial |
$38.23
|
|
|
11740-Evacuation Subungual Hematoma
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8080055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
|
|
11740-Evacuation Subungual Hematoma
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8080055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Devoted Health Medicare |
$170.50
|
| 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 |
$155.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$294.50
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Humana Medicare |
$155.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.00
|
| Rate for Payer: University Health Alliance Commercial |
$225.96
|
|
|
11740 EVACUATION SUBUNGUAL HEMATOMA TechFee
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8022612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.75 |
| Max. Negotiated Rate |
$344.35 |
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.50
|
| Rate for Payer: MDX Hawaii PPO |
$344.35
|
|
|
11740 EVACUATION SUBUNGUAL HEMATOMA TechFee
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
8022612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$177.50
|
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Devoted Health Medicare |
$195.25
|
| 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 |
$177.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$337.25
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Humana Medicare |
$177.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.50
|
| Rate for Payer: MDX Hawaii PPO |
$344.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.50
|
| Rate for Payer: University Health Alliance Commercial |
$258.76
|
|
|
11750-Excision Nail & Matrix
|
Facility
|
OP
|
$1,831.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8080202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,776.07 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$915.50
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Devoted Health Medicare |
$1,007.05
|
| 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 |
$915.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,739.45
|
| Rate for Payer: Health Management Network Commercial |
$1,556.35
|
| Rate for Payer: Humana Medicare |
$915.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,647.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$915.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,776.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$915.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$915.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$915.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,334.62
|
|
|
11750-Excision Nail & Matrix
|
Facility
|
IP
|
$1,831.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8080202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,556.35 |
| Max. Negotiated Rate |
$1,776.07 |
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Health Management Network Commercial |
$1,556.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,647.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,776.07
|
|
|
11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8022613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,817.30 |
| Max. Negotiated Rate |
$2,073.86 |
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Health Management Network Commercial |
$1,817.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,924.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,073.86
|
|
|
11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8022613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$2,073.86 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Devoted Health Medicare |
$1,175.90
|
| 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 |
$1,069.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,031.10
|
| Rate for Payer: Health Management Network Commercial |
$1,817.30
|
| Rate for Payer: Humana Medicare |
$1,069.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,924.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,069.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,073.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,069.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,069.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,069.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,558.39
|
|
|
11750 Excision of nail and nail matrix, partial or complete, for permanent removal
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
8037155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$491.30 |
| Rate for Payer: AlohaCare Medicaid |
$106.66
|
| Rate for Payer: AlohaCare Medicare |
$97.44
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Devoted Health Medicare |
$107.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$253.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.02
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.44
|
| Rate for Payer: University Health Alliance Commercial |
$115.45
|
|
|
11760 REPAIR NAIL BED TechFee
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8022615
|
|
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
|
|
|
11760 REPAIR NAIL BED TechFee
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8022615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$868.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| 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 |
$4,035.20
|
|
|
11760-Repair of Nail Bed
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8080204
|
|
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
|
|
|
11760-Repair of Nail Bed
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
8080204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| 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 |
$4,035.20
|
|
|
11765-Wedge Excision Skin Nail Fold
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
8080206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| 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 Medicare |
$992.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,446.14
|
|
|
11765-Wedge Excision Skin Nail Fold
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
8080206
|
|
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
|
|
