|
11921 Tattooing, intradermal, to correct color defects of skin; 6.1 to 20.0 sq cm
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
8037167
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$133.12
|
| Rate for Payer: AlohaCare Medicare |
$116.65
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$128.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$204.47
|
| 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 |
$105.04
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.98
|
| 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 |
$133.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.65
|
| 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 |
$151.30
|
|
|
11950 Subcutaneous injection of filling material (eg, collagen); 1 cc or less
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 11950
|
| Hospital Charge Code |
8037168
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$51.99
|
| Rate for Payer: AlohaCare Medicare |
$43.96
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Devoted Health Medicare |
$48.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.99
|
| 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 |
$60.58
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.75
|
| 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 |
$51.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.96
|
| 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 |
$59.93
|
|
|
11951 Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11951
|
| Hospital Charge Code |
8037169
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: AlohaCare Medicaid |
$72.79
|
| Rate for Payer: AlohaCare Medicare |
$61.41
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$67.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.00
|
| 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 |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.69
|
| 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 |
$72.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.41
|
| 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 |
$84.36
|
|
|
11952 Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
8037170
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$102.20
|
| Rate for Payer: AlohaCare Medicare |
$86.36
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$95.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.58
|
| 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 |
$82.94
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.63
|
| 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 |
$102.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.36
|
| 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 |
$118.83
|
|
|
11954 Subcutaneous injection of filling material (eg, collagen); over 10.0 cc
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
8037171
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$111.53
|
| Rate for Payer: AlohaCare Medicare |
$94.61
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Devoted Health Medicare |
$104.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.37
|
| 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 |
$90.48
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.53
|
| 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 |
$111.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.61
|
| 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 |
$129.77
|
|
|
11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion
|
Professional
|
Both
|
$4,932.00
|
|
|
Service Code
|
HCPCS 11960
|
| Hospital Charge Code |
8037172
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$4,192.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,073.46
|
| Rate for Payer: AlohaCare Medicare |
$990.01
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Devoted Health Medicare |
$1,089.01
|
| 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 |
$684.84
|
| Rate for Payer: Health Management Network Commercial |
$4,192.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.01
|
| 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 |
$1,073.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$990.01
|
| 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
|
|
|
11971 Removal of tissue expander(s) without insertion of prosthesis
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
8037173
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$578.09
|
| Rate for Payer: AlohaCare Medicare |
$531.21
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$584.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$534.86
|
| 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 |
$214.50
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.45
|
| 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 |
$578.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$531.21
|
| 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
|
|
|
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-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 |
$1,812.50
|
| 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: Devoted Health Medicare |
$1,993.75
|
| 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 |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 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 |
$143.48
|
| 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 |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.11
|
| 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
|
|
|
11976 Removal, implantable contraceptive capsules
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
8037174
|
|
Hospital Revenue Code
|
521
|
| 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: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$85.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$143.48
|
| 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 |
$124.02
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.11
|
| 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 |
$91.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.59
|
| 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 |
$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 |
$117.42
|
| 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 |
$63.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.95
|
| 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
|
|
|
11981 Insertion, non-biodegradable drug delivery implant
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
8037175
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$434.26 |
| 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: Cash Price |
$244.40
|
| Rate for Payer: Devoted Health Medicare |
$58.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.42
|
| 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 |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.95
|
| 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 |
$61.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.29
|
| 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 |
$67.44
|
|
|
11982 Removal, non-biodegradable drug delivery implant
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
8037176
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: AlohaCare Medicaid |
$72.04
|
| Rate for Payer: AlohaCare Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$67.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.86
|
| 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 |
$142.22
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.80
|
| 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 |
$72.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.50
|
| 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 |
$77.91
|
|
|
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 |
$142.86
|
| 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 |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.80
|
| 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
|
$622.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
8037177
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: AlohaCare Medicaid |
$101.67
|
| Rate for Payer: AlohaCare Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$94.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.90
|
| 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 |
$222.82
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.40
|
| 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 |
$101.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.17
|
| 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 |
$110.49
|
|
|
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 |
$251.90
|
| 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 |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.40
|
| 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 |
$393.00
|
| Rate for Payer: AlohaCare Medicare |
$393.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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
|
521
|
| Min. Negotiated Rate |
$43.02 |
| Max. Negotiated Rate |
$434.26 |
| 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: Cash Price |
$235.30
|
| Rate for Payer: Devoted Health Medicare |
$47.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$131.08
|
| 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 |
$83.46
|
| Rate for Payer: Health Management Network Commercial |
$307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.62
|
| 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 |
$43.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.02
|
| 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 |
$131.00
|
|
|
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 |
$131.08
|
| 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 |
$51.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.62
|
| 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 |
$418.00
|
| Rate for Payer: AlohaCare Medicare |
$418.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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
|
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 |
$393.00
|
| Rate for Payer: AlohaCare Medicare |
$393.00
|
| 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 |
$469.00
|
| 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 |
$450.00
|
| 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-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
|
|
