|
12020 Treatment of superficial wound dehiscence simple closure
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
8037189
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: AlohaCare Medicaid |
$195.02
|
| Rate for Payer: AlohaCare Medicare |
$183.26
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Devoted Health Medicare |
$201.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$299.12
|
| 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 |
$76.44
|
| Rate for Payer: Health Management Network Commercial |
$867.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.91
|
| 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 |
$195.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.26
|
| 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 |
$212.61
|
|
|
12020-Treatment Superficial Wound Dehiscence
|
Facility
|
IP
|
$3,227.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
8080005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,742.95 |
| Max. Negotiated Rate |
$3,130.19 |
| Rate for Payer: Cash Price |
$2,097.55
|
| Rate for Payer: Health Management Network Commercial |
$2,742.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,904.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,130.19
|
|
|
12020-Treatment Superficial Wound Dehiscence
|
Facility
|
OP
|
$3,227.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
8080005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,130.19 |
| Rate for Payer: AlohaCare Medicaid |
$1,613.50
|
| Rate for Payer: AlohaCare Medicare |
$1,613.50
|
| Rate for Payer: Cash Price |
$2,097.55
|
| Rate for Payer: Cash Price |
$2,097.55
|
| Rate for Payer: Devoted Health Medicare |
$1,774.85
|
| 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 |
$1,613.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,065.65
|
| Rate for Payer: Health Management Network Commercial |
$2,742.95
|
| Rate for Payer: Humana Medicare |
$1,613.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,904.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,613.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,130.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,613.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,613.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,613.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,352.16
|
|
|
12021 Treatment of superficial wound dehiscence with packing
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
8037190
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: AlohaCare Medicaid |
$147.11
|
| Rate for Payer: AlohaCare Medicare |
$138.48
|
| Rate for Payer: Cash Price |
$388.70
|
| Rate for Payer: Cash Price |
$388.70
|
| Rate for Payer: Cash Price |
$388.70
|
| Rate for Payer: Devoted Health Medicare |
$152.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$225.65
|
| 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 |
$78.78
|
| Rate for Payer: Health Management Network Commercial |
$508.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.18
|
| 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 |
$147.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.48
|
| 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 |
$166.98
|
|
|
12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8022639
|
|
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
|
|
|
12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8022639
|
|
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
|
|
|
12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8037191
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: AlohaCare Medicaid |
$158.83
|
| Rate for Payer: AlohaCare Medicare |
$138.32
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Devoted Health Medicare |
$152.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$242.37
|
| 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 |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$775.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.98
|
| 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 |
$158.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.32
|
| 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 |
$172.77
|
|
|
12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8037191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$158.83
|
| Rate for Payer: AlohaCare Medicare |
$138.32
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Devoted Health Medicare |
$152.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$158.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$242.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$158.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.32
|
| Rate for Payer: University Health Alliance Commercial |
$172.77
|
|
|
12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8080006
|
|
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
|
|
|
12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
8080006
|
|
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
|
|
|
12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8022640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8022640
|
|
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
|
|
|
12032 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 2.6-7.5cm
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8037192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: AlohaCare Medicaid |
$199.83
|
| Rate for Payer: AlohaCare Medicare |
$171.50
|
| Rate for Payer: Cash Price |
$612.95
|
| Rate for Payer: Cash Price |
$612.95
|
| Rate for Payer: Devoted Health Medicare |
$188.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$199.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$303.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$801.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$205.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$199.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.50
|
| Rate for Payer: University Health Alliance Commercial |
$217.60
|
|
|
12032 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 2.6-7.5cm
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8037192
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$884.85 |
| Rate for Payer: AlohaCare Medicaid |
$199.83
|
| Rate for Payer: AlohaCare Medicare |
$171.50
|
| Rate for Payer: Cash Price |
$676.65
|
| Rate for Payer: Cash Price |
$676.65
|
| Rate for Payer: Cash Price |
$676.65
|
| Rate for Payer: Devoted Health Medicare |
$188.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$303.56
|
| 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 |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$884.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.80
|
| 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 |
$199.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.50
|
| 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 |
$217.60
|
|
|
12032-Scalp/Trunk/Extremity 2.6-7.5cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8080008
|
|
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
|
|
|
12032-Scalp/Trunk/Extremity 2.6-7.5cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
8080008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8022641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$421.50
|
| Rate for Payer: AlohaCare Medicare |
$421.50
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Devoted Health Medicare |
$463.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$421.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.85
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Humana Medicare |
$421.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.50
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$421.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8022641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$716.55 |
| Max. Negotiated Rate |
$817.71 |
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
|
|
12034 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 7.6-12.5cm
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8037193
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$963.05 |
| Rate for Payer: AlohaCare Medicaid |
$212.66
|
| Rate for Payer: AlohaCare Medicare |
$184.16
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Cash Price |
$736.45
|
| Rate for Payer: Devoted Health Medicare |
$202.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$325.77
|
| 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 |
$176.54
|
| Rate for Payer: Health Management Network Commercial |
$963.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.99
|
| 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 |
$212.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.16
|
| 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 |
$231.25
|
|
|
12034-Scalp/Trunk/Extremity 7.6-12.5 cm
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8080010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$841.96 |
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Health Management Network Commercial |
$737.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.20
|
| Rate for Payer: MDX Hawaii PPO |
$841.96
|
|
|
12034-Scalp/Trunk/Extremity 7.6-12.5 cm
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
8080010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$434.00
|
| Rate for Payer: AlohaCare Medicare |
$434.00
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Devoted Health Medicare |
$477.40
|
| 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 |
$434.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$824.60
|
| Rate for Payer: Health Management Network Commercial |
$737.80
|
| Rate for Payer: Humana Medicare |
$434.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.00
|
| Rate for Payer: MDX Hawaii PPO |
$841.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8022642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8022642
|
|
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
|
|
|
12035 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 12.6-20.0cm
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8037194
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: AlohaCare Medicaid |
$247.22
|
| Rate for Payer: AlohaCare Medicare |
$228.04
|
| Rate for Payer: Cash Price |
$703.95
|
| Rate for Payer: Cash Price |
$703.95
|
| Rate for Payer: Cash Price |
$703.95
|
| Rate for Payer: Devoted Health Medicare |
$250.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$380.96
|
| 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 |
$210.86
|
| Rate for Payer: Health Management Network Commercial |
$920.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.65
|
| 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 |
$247.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.04
|
| 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 |
$269.13
|
|
|
12035-Scalp/Trunk/Extremity 12.6-20.0 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
8080012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
