|
12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8037179
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$57.36
|
| Rate for Payer: AlohaCare Medicare |
$55.77
|
| Rate for Payer: Cash Price |
$273.65
|
| Rate for Payer: Cash Price |
$273.65
|
| Rate for Payer: Cash Price |
$273.65
|
| Rate for Payer: Devoted Health Medicare |
$61.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.78
|
| 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 |
$111.28
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.92
|
| 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 |
$57.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.77
|
| 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 |
$140.00
|
|
|
12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8022625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$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 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
8022625
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
12004-Scalp/Neck/Trunk/Genital/Extremity 7.6-12.5 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8079996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$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
|
|
|
12004-Scalp/Neck/Trunk/Genital/Extremity 7.6-12.5 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8079996
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Cash Price |
$510.90
|
| Rate for Payer: Health Management Network Commercial |
$668.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.40
|
| Rate for Payer: MDX Hawaii PPO |
$762.42
|
|
|
12004 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 7.6-12.5cm
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8037180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$71.33
|
| Rate for Payer: AlohaCare Medicare |
$69.47
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Devoted Health Medicare |
$76.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$170.75
|
| 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 |
$138.06
|
| Rate for Payer: Health Management Network Commercial |
$405.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.36
|
| 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 |
$71.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.47
|
| 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 |
$82.18
|
|
|
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8022626
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$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
|
|
|
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
8022626
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
12005-Scalp/Neck/Trunk/Genital/Extremity 12.6-20.0 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8079998
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$405.00
|
| Rate for Payer: AlohaCare Medicare |
$405.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Devoted Health Medicare |
$445.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$769.50
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Humana Medicare |
$405.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.00
|
| Rate for Payer: University Health Alliance Commercial |
$590.41
|
|
|
12005-Scalp/Neck/Trunk/Genital/Extremity 12.6-20.0 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8079998
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$688.50 |
| Max. Negotiated Rate |
$785.70 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
|
|
12005 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 12.6-20.0cm
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8037181
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: AlohaCare Medicaid |
$90.64
|
| Rate for Payer: AlohaCare Medicare |
$85.36
|
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Devoted Health Medicare |
$93.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$211.67
|
| 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 |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$519.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.43
|
| 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 |
$90.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.36
|
| 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 |
$106.30
|
|
|
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8022627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.00 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.00
|
| Rate for Payer: MDX Hawaii PPO |
$853.60
|
|
|
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
8022627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$440.00
|
| Rate for Payer: AlohaCare Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Devoted Health Medicare |
$484.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$836.00
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Humana Medicare |
$440.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.00
|
| Rate for Payer: MDX Hawaii PPO |
$853.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$440.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.00
|
| Rate for Payer: University Health Alliance Commercial |
$641.43
|
|
|
12006-Scalp/Neck/Trunk/Genital/Extremity 20.1-30 cm
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8080000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.75 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: Cash Price |
$1,413.75
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
|
|
12006-Scalp/Neck/Trunk/Genital/Extremity 20.1-30 cm
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8080000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,109.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,087.50
|
| Rate for Payer: AlohaCare Medicare |
$1,087.50
|
| Rate for Payer: Cash Price |
$1,413.75
|
| Rate for Payer: Cash Price |
$1,413.75
|
| Rate for Payer: Devoted Health Medicare |
$1,196.25
|
| 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 |
$1,087.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,066.25
|
| Rate for Payer: Health Management Network Commercial |
$1,848.75
|
| Rate for Payer: Humana Medicare |
$1,087.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,957.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,087.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,109.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,087.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,087.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,585.36
|
|
|
12006 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 20.1-30.0cm
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8037182
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$591.60 |
| Rate for Payer: AlohaCare Medicaid |
$111.28
|
| Rate for Payer: AlohaCare Medicare |
$104.02
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Devoted Health Medicare |
$114.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$266.54
|
| 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 |
$169.52
|
| Rate for Payer: Health Management Network Commercial |
$591.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.82
|
| 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 |
$111.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.02
|
| 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 |
$130.81
|
|
|
12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8022628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,471.56 |
| Rate for Payer: AlohaCare Medicaid |
$1,274.00
|
| Rate for Payer: AlohaCare Medicare |
$1,274.00
|
| Rate for Payer: Cash Price |
$1,656.20
|
| Rate for Payer: Cash Price |
$1,656.20
|
| Rate for Payer: Devoted Health Medicare |
$1,401.40
|
| 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 |
$1,274.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,420.60
|
| Rate for Payer: Health Management Network Commercial |
$2,165.80
|
| Rate for Payer: Humana Medicare |
$1,274.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,293.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,274.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,471.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,274.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,274.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,274.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,857.24
|
|
|
12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
8022628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,165.80 |
| Max. Negotiated Rate |
$2,471.56 |
| Rate for Payer: Cash Price |
$1,656.20
|
| Rate for Payer: Health Management Network Commercial |
$2,165.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,293.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,471.56
|
|
|
12007-Scalp/Neck/Trunk/Genital/Extremity Greater Than 30 cm
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
8080002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.05 |
| Max. Negotiated Rate |
$1,099.01 |
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
|
|
12007-Scalp/Neck/Trunk/Genital/Extremity Greater Than 30 cm
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
8080002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$566.50
|
| Rate for Payer: AlohaCare Medicare |
$566.50
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Devoted Health Medicare |
$623.15
|
| 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 |
$566.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,076.35
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Humana Medicare |
$566.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,019.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,099.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$566.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.50
|
| Rate for Payer: University Health Alliance Commercial |
$825.84
|
|
|
12007 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; >30.0cm
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
8037183
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: AlohaCare Medicaid |
$138.73
|
| Rate for Payer: AlohaCare Medicare |
$127.78
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Devoted Health Medicare |
$140.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$303.03
|
| 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 |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$595.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.34
|
| 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 |
$138.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.78
|
| 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 |
$163.91
|
|
|
12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8080004
|
|
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
|
|
|
12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8080004
|
|
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
|
|
|
12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8022630
|
|
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
|
|
|
12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8022630
|
|
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
|
|
