|
11770 Excision of pilonidal cyst or sinus simple
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
8037161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$189.25
|
| Rate for Payer: AlohaCare Medicare |
$182.61
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$200.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$317.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$210.08
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.61
|
| Rate for Payer: University Health Alliance Commercial |
$204.13
|
|
|
11771 Excision of pilonidal cyst or sinus; extensive
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
8037162
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$411.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$463.32
|
| Rate for Payer: AlohaCare Medicare |
$448.60
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$493.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$463.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$769.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$463.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$411.32
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$493.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$493.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$493.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$463.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$463.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.60
|
| Rate for Payer: University Health Alliance Commercial |
$502.84
|
|
|
11976-Contraceptive Capsule
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
8080139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
11976-Contraceptive Capsule
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
8080139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
11976 Removal, implantable contraceptive capsules
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
8037174
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.59 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: AlohaCare Medicaid |
$91.24
|
| Rate for Payer: AlohaCare Medicare |
$77.59
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$85.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$91.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.02
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$91.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.59
|
| Rate for Payer: University Health Alliance Commercial |
$98.21
|
|
|
11981 Insertion, non-biodegradable drug delivery implant
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
8037175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: AlohaCare Medicaid |
$61.76
|
| Rate for Payer: AlohaCare Medicare |
$53.29
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Devoted Health Medicare |
$58.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$126.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.29
|
| Rate for Payer: University Health Alliance Commercial |
$67.44
|
|
|
11982 Removal, non-biodegradable drug delivery implant
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
8037176
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: AlohaCare Medicaid |
$72.04
|
| Rate for Payer: AlohaCare Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Devoted Health Medicare |
$67.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$72.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$153.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$72.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.22
|
| Rate for Payer: Health Management Network Commercial |
$345.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.91
|
|
|
11983 Removal with reinsertion, non-biodegradable drug delivery implant
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
8037177
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$422.45 |
| Rate for Payer: AlohaCare Medicaid |
$101.67
|
| Rate for Payer: AlohaCare Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$323.05
|
| Rate for Payer: Cash Price |
$323.05
|
| Rate for Payer: Devoted Health Medicare |
$94.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$270.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.82
|
| Rate for Payer: Health Management Network Commercial |
$422.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.17
|
| Rate for Payer: University Health Alliance Commercial |
$110.49
|
|
|
12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8079992
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$393.00
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Devoted Health Medicare |
$432.30
|
| 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 |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.70
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Humana Medicare |
$393.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.00
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.00
|
| Rate for Payer: University Health Alliance Commercial |
$572.92
|
|
|
12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8079992
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
|
|
12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8037178
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.02 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: AlohaCare Medicaid |
$43.95
|
| Rate for Payer: AlohaCare Medicare |
$43.02
|
| Rate for Payer: Cash Price |
$235.30
|
| Rate for Payer: Cash Price |
$235.30
|
| Rate for Payer: Devoted Health Medicare |
$47.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$43.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$140.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.02
|
| Rate for Payer: University Health Alliance Commercial |
$131.00
|
|
|
12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8022624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
8022624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$418.00
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Devoted Health Medicare |
$459.80
|
| 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 |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.20
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Humana Medicare |
$418.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.00
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$418.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.00
|
| Rate for Payer: University Health Alliance Commercial |
$609.36
|
|
|
12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8079994
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
|
|
12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8079994
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$393.00
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Devoted Health Medicare |
$432.30
|
| 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 |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.70
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Humana Medicare |
$393.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.00
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.00
|
| Rate for Payer: University Health Alliance Commercial |
$572.92
|
|
|
12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8022625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8022625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$418.00
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Devoted Health Medicare |
$459.80
|
| 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 |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.20
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Humana Medicare |
$418.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.00
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$418.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.00
|
| Rate for Payer: University Health Alliance Commercial |
$609.36
|
|
|
12004-Scalp/Neck/Trunk/Genital/Extremity 7.6-12.5 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8079996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$393.00
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Devoted Health Medicare |
$432.30
|
| 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 |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$746.70
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Humana Medicare |
$393.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.00
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.00
|
| Rate for Payer: University Health Alliance Commercial |
$572.92
|
|
|
12004-Scalp/Neck/Trunk/Genital/Extremity 7.6-12.5 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8079996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
|
|
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8022626
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$418.00
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Devoted Health Medicare |
$459.80
|
| 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 |
$418.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.20
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Humana Medicare |
$418.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$418.00
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$418.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.00
|
| Rate for Payer: University Health Alliance Commercial |
$609.36
|
|
|
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8022626
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
12005-Scalp/Neck/Trunk/Genital/Extremity 12.6-20.0 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8079998
|
|
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
|
|
|
12005-Scalp/Neck/Trunk/Genital/Extremity 12.6-20.0 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8079998
|
|
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
|
|
|
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8022627
|
|
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
|
|
|
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8022627
|
|
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
|
|
