|
41116 Excision, lesion of floor of mouth
|
Professional
|
Both
|
$4,614.00
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
8039136
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$3,921.90 |
| Rate for Payer: AlohaCare Medicaid |
$230.98
|
| Rate for Payer: AlohaCare Medicare |
$211.03
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Devoted Health Medicare |
$232.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.54
|
| Rate for Payer: Health Management Network Commercial |
$3,921.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$253.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$298.18
|
|
|
41120 Glossectomy; less than one-half tongue
|
Professional
|
Both
|
$8,239.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
8039137
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$7,003.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,125.28
|
| Rate for Payer: AlohaCare Medicare |
$1,031.88
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Devoted Health Medicare |
$1,135.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$675.22
|
| Rate for Payer: Health Management Network Commercial |
$7,003.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,031.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41130 Glossectomy; hemiglossectomy
|
Professional
|
Both
|
$3,696.00
|
|
|
Service Code
|
HCPCS 41130
|
| Hospital Charge Code |
8039138
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,141.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,375.81
|
| Rate for Payer: AlohaCare Medicare |
$1,234.30
|
| Rate for Payer: Cash Price |
$2,402.40
|
| Rate for Payer: Cash Price |
$2,402.40
|
| Rate for Payer: Cash Price |
$2,402.40
|
| Rate for Payer: Devoted Health Medicare |
$1,357.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.32
|
| Rate for Payer: Health Management Network Commercial |
$3,141.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,481.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,375.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,234.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41135 Glossectomy; partial, with unilateral radical neck dissection
|
Professional
|
Both
|
$5,810.00
|
|
|
Service Code
|
HCPCS 41135
|
| Hospital Charge Code |
8039139
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,938.50 |
| Rate for Payer: Cash Price |
$3,776.50
|
| Rate for Payer: AlohaCare Medicaid |
$2,235.34
|
| Rate for Payer: AlohaCare Medicare |
$1,963.74
|
| Rate for Payer: Cash Price |
$3,776.50
|
| Rate for Payer: Cash Price |
$3,776.50
|
| Rate for Payer: Devoted Health Medicare |
$2,160.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,226.16
|
| Rate for Payer: Health Management Network Commercial |
$4,938.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,356.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,235.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,963.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41150 Glossectomy; composite procedure, without radical neck dissection
|
Professional
|
Both
|
$5,903.00
|
|
|
Service Code
|
HCPCS 41150
|
| Hospital Charge Code |
8039140
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$5,017.55 |
| Rate for Payer: AlohaCare Medicaid |
$2,273.46
|
| Rate for Payer: AlohaCare Medicare |
$1,994.82
|
| Rate for Payer: Cash Price |
$3,836.95
|
| Rate for Payer: Cash Price |
$3,836.95
|
| Rate for Payer: Cash Price |
$3,836.95
|
| Rate for Payer: Devoted Health Medicare |
$2,194.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,242.80
|
| Rate for Payer: Health Management Network Commercial |
$5,017.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,393.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,273.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,994.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41153 Glossectomy; composite procedure, with suprahyoid neck dissection
|
Professional
|
Both
|
$6,374.00
|
|
|
Service Code
|
HCPCS 41153
|
| Hospital Charge Code |
8039141
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$5,417.90 |
| Rate for Payer: AlohaCare Medicaid |
$2,464.70
|
| Rate for Payer: AlohaCare Medicare |
$2,149.43
|
| Rate for Payer: Cash Price |
$4,143.10
|
| Rate for Payer: Cash Price |
$4,143.10
|
| Rate for Payer: Cash Price |
$4,143.10
|
| Rate for Payer: Devoted Health Medicare |
$2,364.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,428.44
|
| Rate for Payer: Health Management Network Commercial |
$5,417.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,579.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,464.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,149.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41155 Glossectomy; composite procedure, Commando type
|
Professional
|
Both
|
$7,824.00
|
|
|
Service Code
|
HCPCS 41155
|
| Hospital Charge Code |
8039142
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$6,650.40 |
| Rate for Payer: AlohaCare Medicaid |
$3,054.63
|
| Rate for Payer: AlohaCare Medicare |
$2,653.65
|
| Rate for Payer: Cash Price |
$5,085.60
|
| Rate for Payer: Cash Price |
$5,085.60
|
| Rate for Payer: Cash Price |
$5,085.60
|
| Rate for Payer: Devoted Health Medicare |
$2,919.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,686.62
|
| Rate for Payer: Health Management Network Commercial |
$6,650.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,184.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,054.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,653.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41250-Mouth Floor/Tongue Ant 2/3 Less Than/Equal to 2.5cm
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8080039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.65 |
| Max. Negotiated Rate |
$784.73 |
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
|
|
41250-Mouth Floor/Tongue Ant 2/3 Less Than/Equal to 2.5cm
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8080039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$404.50
|
| Rate for Payer: AlohaCare Medicare |
$404.50
|
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Devoted Health Medicare |
$444.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$404.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$768.55
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Humana Medicare |
$404.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$404.50
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$404.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$404.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.50
|
| Rate for Payer: University Health Alliance Commercial |
$589.68
|
|
|
41250 Repair of laceration 2.5 cm or less floor of mouth and/or anterior two thirds of tongue
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8039143
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: AlohaCare Medicaid |
$160.31
|
| Rate for Payer: AlohaCare Medicare |
$172.94
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Cash Price |
$464.75
|
| Rate for Payer: Devoted Health Medicare |
$190.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$245.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.38
|
| Rate for Payer: Health Management Network Commercial |
$607.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$207.99
|
|
|
41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG TechFee
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8211317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$747.15 |
| Max. Negotiated Rate |
$852.63 |
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
|
|
41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG TechFee
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
8211317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$439.50
|
| Rate for Payer: AlohaCare Medicare |
$439.50
|
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Devoted Health Medicare |
$483.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$439.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$835.05
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Humana Medicare |
$439.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$439.50
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$439.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$439.50
|
| Rate for Payer: University Health Alliance Commercial |
$640.70
|
|
|
41251-MF/T Posterior 1/3 Less Than/Equal to 2.5 cm
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
8080038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$658.00
|
| Rate for Payer: AlohaCare Medicare |
$658.00
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Devoted Health Medicare |
$723.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$658.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,250.20
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Humana Medicare |
$658.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.00
|
| Rate for Payer: University Health Alliance Commercial |
$959.23
|
|
|
41251-MF/T Posterior 1/3 Less Than/Equal to 2.5 cm
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
8080038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,118.60 |
| Max. Negotiated Rate |
$1,276.52 |
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
|
|
41252-MF/T Complex 1/3 Greater Than 2.6cm
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
8080040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,118.60 |
| Max. Negotiated Rate |
$1,276.52 |
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
|
|
41252-MF/T Complex 1/3 Greater Than 2.6cm
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
8080040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$658.00
|
| Rate for Payer: AlohaCare Medicare |
$658.00
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Devoted Health Medicare |
$723.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$658.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,250.20
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Humana Medicare |
$658.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
41252 Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
8039144
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$781.15 |
| Rate for Payer: AlohaCare Medicaid |
$215.81
|
| Rate for Payer: AlohaCare Medicare |
$199.39
|
| 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 |
$219.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$332.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.72
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$239.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$281.51
|
|
|
41520 Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
|
Professional
|
Both
|
$4,614.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
8039145
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,921.90 |
| Rate for Payer: AlohaCare Medicaid |
$269.20
|
| Rate for Payer: AlohaCare Medicare |
$241.96
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Devoted Health Medicare |
$266.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$410.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.36
|
| Rate for Payer: Health Management Network Commercial |
$3,921.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
41800-Drainage Abscess/Cyst Dentoalveolar
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8080046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$682.55 |
| Max. Negotiated Rate |
$778.91 |
| Rate for Payer: Cash Price |
$521.95
|
| Rate for Payer: Health Management Network Commercial |
$682.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$722.70
|
| Rate for Payer: MDX Hawaii PPO |
$778.91
|
|
|
41800-Drainage Abscess/Cyst Dentoalveolar
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8080046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$401.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$401.50
|
| Rate for Payer: AlohaCare Medicare |
$401.50
|
| Rate for Payer: Cash Price |
$521.95
|
| Rate for Payer: Cash Price |
$521.95
|
| Rate for Payer: Devoted Health Medicare |
$441.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$762.85
|
| Rate for Payer: Health Management Network Commercial |
$682.55
|
| Rate for Payer: Humana Medicare |
$401.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$722.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$401.50
|
| Rate for Payer: MDX Hawaii PPO |
$778.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$401.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.50
|
| Rate for Payer: University Health Alliance Commercial |
$585.31
|
|
|
41800 Drainage of abscess, cyst, hematoma from dentoalveolar structures
|
Professional
|
Both
|
$973.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8039147
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$827.05 |
| Rate for Payer: AlohaCare Medicaid |
$167.63
|
| Rate for Payer: AlohaCare Medicare |
$204.43
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Devoted Health Medicare |
$224.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$249.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.04
|
| Rate for Payer: Health Management Network Commercial |
$827.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$213.94
|
|
|
41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS TechFee
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8211318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$436.50
|
| Rate for Payer: AlohaCare Medicare |
$436.50
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Devoted Health Medicare |
$480.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$436.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$829.35
|
| Rate for Payer: Health Management Network Commercial |
$742.05
|
| Rate for Payer: Humana Medicare |
$436.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$785.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$436.50
|
| Rate for Payer: MDX Hawaii PPO |
$846.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$436.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$436.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$436.50
|
| Rate for Payer: University Health Alliance Commercial |
$636.33
|
|
|
41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS TechFee
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
8211318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.05 |
| Max. Negotiated Rate |
$846.81 |
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Health Management Network Commercial |
$742.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$785.70
|
| Rate for Payer: MDX Hawaii PPO |
$846.81
|
|
|
41805 Removal of embedded foreign body from dentoalveolar structures; soft tissues
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 41805
|
| Hospital Charge Code |
8039148
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$1,835.15 |
| Rate for Payer: AlohaCare Medicaid |
$214.74
|
| Rate for Payer: AlohaCare Medicare |
$208.45
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Devoted Health Medicare |
$229.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$305.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.32
|
| Rate for Payer: Health Management Network Commercial |
$1,835.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$250.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$286.08
|
|
|
41806 Removal of embedded foreign body from dentoalveolar structures; bone
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 41806
|
| Hospital Charge Code |
8039149
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$1,835.15 |
| Rate for Payer: AlohaCare Medicaid |
$297.56
|
| Rate for Payer: AlohaCare Medicare |
$278.60
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Devoted Health Medicare |
$306.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$463.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$128.96
|
| Rate for Payer: Health Management Network Commercial |
$1,835.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$334.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$396.51
|
|
