|
97012 Traction Mechanical
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 97012 GP,CQ
|
| Hospital Charge Code |
8222667
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$63.50
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$69.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.65
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$63.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.50
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.50
|
| Rate for Payer: University Health Alliance Commercial |
$92.57
|
|
|
97028 Application of a modality to 1 or more areas; ultraviolet
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 97028
|
| Hospital Charge Code |
8831468
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: AlohaCare Medicaid |
$8.97
|
| Rate for Payer: AlohaCare Medicare |
$8.94
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Devoted Health Medicare |
$9.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.75
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.94
|
|
|
97110 - Theurapeutic Proc Ea 15 min
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97110 GP,CQ
|
| Hospital Charge Code |
8409226
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
97110 - Theurapeutic Proc Ea 15 min
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97110 GP,CQ
|
| Hospital Charge Code |
8409226
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.65 |
| 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 Medicare |
$99.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| 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 |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.50
|
| Rate for Payer: University Health Alliance Commercial |
$145.05
|
|
|
97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN CH
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GO,59
|
| Hospital Charge Code |
8933483
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
97140 MANUAL THERAPY TECHNIQUES PLUS EA 15 MIN CH
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GO,59
|
| Hospital Charge Code |
8933483
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
97140 PT Manual Therapy Assistant Units
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GP,59
|
| Hospital Charge Code |
9438781
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
97140 PT Manual Therapy Assistant Units
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 97140 GP,59
|
| Hospital Charge Code |
9438781
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
97530 PT Therapeutic Activity Assistant Units
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530 GO,59
|
| Hospital Charge Code |
9438786
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
|
|
97530 PT Therapeutic Activity Assistant Units
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530 GO,59
|
| Hospital Charge Code |
9438786
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: AlohaCare Medicaid |
$123.00
|
| Rate for Payer: AlohaCare Medicare |
$123.00
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Devoted Health Medicare |
$135.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.70
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$123.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.00
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.00
|
| Rate for Payer: University Health Alliance Commercial |
$179.31
|
|
|
97597 Debridement, open wound; first 20 sq cm or less
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8040894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$35.17
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.88
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.95
|
| Rate for Payer: University Health Alliance Commercial |
$145.00
|
|
|
97597 Debride Select 1st 20cm or less Charges
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
8221486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
|
|
97597 Debride Select 1st 20cm or less Charges
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597 GP
|
| Hospital Charge Code |
8221486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$300.00
|
| Rate for Payer: AlohaCare Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$330.00
|
| 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 |
$300.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Humana Medicare |
$300.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.00
|
| Rate for Payer: University Health Alliance Commercial |
$437.34
|
|
|
97597-Devitalized Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8080159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
|
|
97597-Devitalized Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8080159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$330.00
|
| 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 |
$300.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Humana Medicare |
$300.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.00
|
| Rate for Payer: University Health Alliance Commercial |
$437.34
|
|
|
97598 Debridement, open wound; each additional 20 sq cm, or part thereof
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8040895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: AlohaCare Medicaid |
$24.27
|
| Rate for Payer: AlohaCare Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$23.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$74.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.18
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.32
|
|
|
97598 Debride Select Ea Addl 20cm Charges
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
8221487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
97598 Debride Select Ea Addl 20cm Charges
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
8221487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: AlohaCare Medicaid |
$137.50
|
| Rate for Payer: AlohaCare Medicare |
$137.50
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$151.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$137.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.50
|
| Rate for Payer: University Health Alliance Commercial |
$200.45
|
|
|
97598-Devitalized Tissue, Each Additional 20 sq cm
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9394270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$137.50
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$151.25
|
| 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 |
$137.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$137.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.50
|
| Rate for Payer: University Health Alliance Commercial |
$200.45
|
|
|
97598-Devitalized Tissue, Each Additional 20 sq cm
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9394270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
97602 ACTIVE WOUND CARE MANAGEMENT TechFee
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8258868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$245.50
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Devoted Health Medicare |
$270.05
|
| 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 |
$245.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$466.45
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Humana Medicare |
$245.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.50
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.50
|
| Rate for Payer: University Health Alliance Commercial |
$357.89
|
|
|
97602 ACTIVE WOUND CARE MANAGEMENT TechFee
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8258868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$476.27 |
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
|
|
97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8040896
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.31
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.46
|
|
|
97605 Negative pressure wound therapy; total wound(s) surface area less than or equal to 50 sq cm
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8040897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: AlohaCare Medicaid |
$24.61
|
| Rate for Payer: AlohaCare Medicare |
$21.27
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$23.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$35.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.67
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.27
|
| Rate for Payer: University Health Alliance Commercial |
$30.44
|
|
|
97605 Neg Press Wound Tx < 50 CM Charges
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8221507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicare |
$198.00
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$217.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$256.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$376.20
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Humana Medicare |
$198.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.00
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.00
|
| Rate for Payer: University Health Alliance Commercial |
$288.64
|
|
