|
12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
8037184
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$54.07
|
| Rate for Payer: AlohaCare Medicare |
$52.86
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Devoted Health Medicare |
$58.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$135.93
|
| 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 |
$106.08
|
| Rate for Payer: Health Management Network Commercial |
$353.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.43
|
| 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 |
$54.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.86
|
| 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 |
$62.33
|
|
|
12013-Face/Ear/Eyelid/Nose/Lip 2.6-5.0 cm
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
8079993
|
|
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
|
|
|
12013-Face/Ear/Eyelid/Nose/Lip 2.6-5.0 cm
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
8079993
|
|
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
|
|
|
12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
8022631
|
|
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
|
|
|
12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
8022631
|
|
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
|
|
|
12013 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
8037185
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$55.42
|
| Rate for Payer: AlohaCare Medicare |
$52.94
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$58.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$155.51
|
| 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 |
$125.06
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.53
|
| 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 |
$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 |
$55.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.94
|
| 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
|
|
|
12014-Face/Ear/Eyelid/Nose/Lip 5.1-7.5 cm
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
8079995
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
12014-Face/Ear/Eyelid/Nose/Lip 5.1-7.5 cm
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
8079995
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$349.50
|
| Rate for Payer: AlohaCare Medicare |
$349.50
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$384.45
|
| 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 |
$349.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$664.05
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$349.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$349.50
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.50
|
| Rate for Payer: University Health Alliance Commercial |
$509.50
|
|
|
12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
8022632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$653.65 |
| Max. Negotiated Rate |
$745.93 |
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Health Management Network Commercial |
$653.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$692.10
|
| Rate for Payer: MDX Hawaii PPO |
$745.93
|
|
|
12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
8022632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$384.50
|
| Rate for Payer: AlohaCare Medicare |
$384.50
|
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Devoted Health Medicare |
$422.95
|
| 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 |
$384.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$730.55
|
| Rate for Payer: Health Management Network Commercial |
$653.65
|
| Rate for Payer: Humana Medicare |
$384.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$692.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$384.50
|
| Rate for Payer: MDX Hawaii PPO |
$745.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$384.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$384.50
|
| Rate for Payer: University Health Alliance Commercial |
$560.52
|
|
|
12014 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; 5.1-7.5cm
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
8037186
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$71.62
|
| Rate for Payer: AlohaCare Medicare |
$68.32
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Devoted Health Medicare |
$75.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$185.08
|
| 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 |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.98
|
| 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 |
$71.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.32
|
| 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 |
$83.44
|
|
|
12015-Face/Ear/Eyelid/Nose/Lip 7.6-12.5 cm
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8079997
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
12015-Face/Ear/Eyelid/Nose/Lip 7.6-12.5 cm
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8079997
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$349.50
|
| Rate for Payer: AlohaCare Medicare |
$349.50
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$384.45
|
| 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 |
$349.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$664.05
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$349.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$349.50
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$349.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$349.50
|
| Rate for Payer: University Health Alliance Commercial |
$509.50
|
|
|
12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8022633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$653.65 |
| Max. Negotiated Rate |
$745.93 |
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Health Management Network Commercial |
$653.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$692.10
|
| Rate for Payer: MDX Hawaii PPO |
$745.93
|
|
|
12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8022633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$384.50
|
| Rate for Payer: AlohaCare Medicare |
$384.50
|
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Cash Price |
$499.85
|
| Rate for Payer: Devoted Health Medicare |
$422.95
|
| 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 |
$384.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$730.55
|
| Rate for Payer: Health Management Network Commercial |
$653.65
|
| Rate for Payer: Humana Medicare |
$384.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$692.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$384.50
|
| Rate for Payer: MDX Hawaii PPO |
$745.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$384.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$384.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$384.50
|
| Rate for Payer: University Health Alliance Commercial |
$560.52
|
|
|
12015 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra;7.5-12.5cm
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
8037187
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$445.40 |
| Rate for Payer: AlohaCare Medicaid |
$89.83
|
| Rate for Payer: AlohaCare Medicare |
$85.51
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Cash Price |
$340.60
|
| Rate for Payer: Devoted Health Medicare |
$94.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.30
|
| 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 |
$147.16
|
| Rate for Payer: Health Management Network Commercial |
$445.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.61
|
| 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 |
$89.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.51
|
| 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 |
$105.37
|
|
|
12016-Face/Ear/Eyelid/Nose/Lip 12.6-20.0 cm
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
8079999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,085.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,075.00
|
| Rate for Payer: AlohaCare Medicare |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,397.50
|
| Rate for Payer: Cash Price |
$1,397.50
|
| Rate for Payer: Devoted Health Medicare |
$1,182.50
|
| 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 |
$1,075.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,042.50
|
| Rate for Payer: Health Management Network Commercial |
$1,827.50
|
| Rate for Payer: Humana Medicare |
$1,075.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,935.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,075.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,085.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,075.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,075.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,075.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,567.13
|
|
|
12016-Face/Ear/Eyelid/Nose/Lip 12.6-20.0 cm
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
8079999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,827.50 |
| Max. Negotiated Rate |
$2,085.50 |
| Rate for Payer: Cash Price |
$1,397.50
|
| Rate for Payer: Health Management Network Commercial |
$1,827.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,935.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,085.50
|
|
|
12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
8022634
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,140.30 |
| Max. Negotiated Rate |
$2,442.46 |
| Rate for Payer: Cash Price |
$1,636.70
|
| Rate for Payer: Health Management Network Commercial |
$2,140.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,266.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,442.46
|
|
|
12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
8022634
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,442.46 |
| Rate for Payer: AlohaCare Medicaid |
$1,259.00
|
| Rate for Payer: AlohaCare Medicare |
$1,259.00
|
| Rate for Payer: Cash Price |
$1,636.70
|
| Rate for Payer: Cash Price |
$1,636.70
|
| Rate for Payer: Devoted Health Medicare |
$1,384.90
|
| 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 |
$1,259.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,392.10
|
| Rate for Payer: Health Management Network Commercial |
$2,140.30
|
| Rate for Payer: Humana Medicare |
$1,259.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,266.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,259.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,442.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,259.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,259.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,259.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,835.37
|
|
|
12017-Face/Ear/Eyelid/Nose/Lip 20.1-30.0 cm
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
8080001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.40 |
| Max. Negotiated Rate |
$1,924.48 |
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
|
|
12017-Face/Ear/Eyelid/Nose/Lip 20.1-30.0 cm
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
8080001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,924.48 |
| Rate for Payer: AlohaCare Medicaid |
$992.00
|
| Rate for Payer: AlohaCare Medicare |
$992.00
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Devoted Health Medicare |
$1,091.20
|
| 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 |
$992.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,884.80
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Humana Medicare |
$992.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$992.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$992.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$992.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$992.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,446.14
|
|
|
12017 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; 20.1-30.0cm
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
8037188
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$146.66 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$146.66
|
| Rate for Payer: AlohaCare Medicare |
$146.73
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$161.40
|
| 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 |
$245.70
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.08
|
| 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 |
$146.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.73
|
| 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
|
|
|
12018-Face/Ear/Eyelid/Nose/Lip Greater Than 30.0 cm
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
8080003
|
|
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
|
|
|
12018-Face/Ear/Eyelid/Nose/Lip Greater Than 30.0 cm
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
8080003
|
|
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
|
|
