|
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
|
|
|
12036 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 20.1-30.0cm
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
8037195
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: AlohaCare Medicaid |
$285.75
|
| Rate for Payer: AlohaCare Medicare |
$271.61
|
| Rate for Payer: Cash Price |
$763.10
|
| Rate for Payer: Cash Price |
$763.10
|
| Rate for Payer: Cash Price |
$763.10
|
| Rate for Payer: Devoted Health Medicare |
$298.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.20
|
| 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 |
$265.72
|
| Rate for Payer: Health Management Network Commercial |
$997.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.93
|
| 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 |
$285.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$271.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$329.45
|
|
|
12036-Scalp/Trunk/Extremity 20.1-30.0 cm
|
Facility
|
IP
|
$3,028.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
8080014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,573.80 |
| Max. Negotiated Rate |
$2,937.16 |
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Health Management Network Commercial |
$2,573.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,725.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,937.16
|
|
|
12036-Scalp/Trunk/Extremity 20.1-30.0 cm
|
Facility
|
OP
|
$3,028.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
8080014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,937.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,514.00
|
| Rate for Payer: AlohaCare Medicare |
$1,514.00
|
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Devoted Health Medicare |
$1,665.40
|
| 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 |
$1,514.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,876.60
|
| Rate for Payer: Health Management Network Commercial |
$2,573.80
|
| Rate for Payer: Humana Medicare |
$1,514.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,725.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,514.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,937.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,514.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,514.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,514.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,207.11
|
|
|
12037 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; over 30.0 cm
|
Professional
|
Both
|
$2,872.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
8037196
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$2,441.20 |
| Rate for Payer: AlohaCare Medicaid |
$330.81
|
| Rate for Payer: AlohaCare Medicare |
$307.49
|
| Rate for Payer: Cash Price |
$1,866.80
|
| Rate for Payer: Cash Price |
$1,866.80
|
| Rate for Payer: Cash Price |
$1,866.80
|
| Rate for Payer: Devoted Health Medicare |
$338.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$514.55
|
| 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 |
$318.50
|
| Rate for Payer: Health Management Network Commercial |
$2,441.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$368.99
|
| 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 |
$330.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.49
|
| 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 |
$380.76
|
|
|
12037-Scalp/Trunk/Extremity Greater Than 30.0 cm
|
Facility
|
OP
|
$8,091.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
8080016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,848.27 |
| Rate for Payer: AlohaCare Medicaid |
$4,045.50
|
| Rate for Payer: AlohaCare Medicare |
$4,045.50
|
| Rate for Payer: Cash Price |
$5,259.15
|
| Rate for Payer: Cash Price |
$5,259.15
|
| Rate for Payer: Devoted Health Medicare |
$4,450.05
|
| 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 |
$4,045.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,686.45
|
| Rate for Payer: Health Management Network Commercial |
$6,877.35
|
| Rate for Payer: Humana Medicare |
$4,045.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,281.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,045.50
|
| Rate for Payer: MDX Hawaii PPO |
$7,848.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,045.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,045.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,045.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,897.53
|
|
|
12037-Scalp/Trunk/Extremity Greater Than 30.0 cm
|
Facility
|
IP
|
$8,091.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
8080016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,877.35 |
| Max. Negotiated Rate |
$7,848.27 |
| Rate for Payer: Cash Price |
$5,259.15
|
| Rate for Payer: Health Management Network Commercial |
$6,877.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,281.90
|
| Rate for Payer: MDX Hawaii PPO |
$7,848.27
|
|
|
12041-Neck/Hand/Feet/Genital Less Than/Equal to 2.5 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8080018
|
|
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
|
|
|
12041-Neck/Hand/Feet/Genital Less Than/Equal to 2.5 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8080018
|
|
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
|
|
|
12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8022645
|
|
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
|
|
|
12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8022645
|
|
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
|
|
|
12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; <2.5cm
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
8037197
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: AlohaCare Medicaid |
$150.87
|
| Rate for Payer: AlohaCare Medicare |
$132.93
|
| 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 |
$146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$229.22
|
| 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 |
$135.72
|
| Rate for Payer: Health Management Network Commercial |
$775.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.52
|
| 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 |
$150.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.93
|
| 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 |
$164.58
|
|
|
12042-Neck/Hand/Feet/Genital 2.6-7.5 cm
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$576.18 |
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
|
|
12042-Neck/Hand/Feet/Genital 2.6-7.5 cm
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$297.00
|
| Rate for Payer: AlohaCare Medicare |
$297.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Devoted Health Medicare |
$326.70
|
| 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 |
$297.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$564.30
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Humana Medicare |
$297.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.00
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.00
|
| Rate for Payer: University Health Alliance Commercial |
$432.97
|
|
|
12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8022646
|
|
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
|
|
|
12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8022646
|
|
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
|
|
|
12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6-7.5cm
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8037198
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: AlohaCare Medicaid |
$203.83
|
| Rate for Payer: AlohaCare Medicare |
$173.37
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Devoted Health Medicare |
$190.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$311.75
|
| 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 |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$897.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.04
|
| 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 |
$203.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.37
|
| 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 |
$221.92
|
|
|
12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6-7.5cm
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
8037198
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: AlohaCare Medicaid |
$203.83
|
| Rate for Payer: AlohaCare Medicare |
$173.37
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Devoted Health Medicare |
$190.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$203.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$311.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$203.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.64
|
| Rate for Payer: Health Management Network Commercial |
$897.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$208.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$203.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.37
|
| Rate for Payer: University Health Alliance Commercial |
$221.92
|
|
|
12044-Neck/Hand/Feet/Genital 7.6-12.5 cm
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8080022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$750.00
|
| Rate for Payer: AlohaCare Medicare |
$750.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Devoted Health Medicare |
$825.00
|
| 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 |
$750.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Humana Medicare |
$750.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$750.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$750.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,093.35
|
|
|
12044-Neck/Hand/Feet/Genital 7.6-12.5 cm
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8080022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
|
|
12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8022647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,476.45 |
| Max. Negotiated Rate |
$1,684.89 |
| Rate for Payer: Cash Price |
$1,129.05
|
| Rate for Payer: Health Management Network Commercial |
$1,476.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,563.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,684.89
|
|
|
12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8022647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,684.89 |
| Rate for Payer: AlohaCare Medicaid |
$868.50
|
| Rate for Payer: AlohaCare Medicare |
$868.50
|
| Rate for Payer: Cash Price |
$1,129.05
|
| Rate for Payer: Cash Price |
$1,129.05
|
| Rate for Payer: Devoted Health Medicare |
$955.35
|
| 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 |
$868.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,650.15
|
| Rate for Payer: Health Management Network Commercial |
$1,476.45
|
| Rate for Payer: Humana Medicare |
$868.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,563.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$868.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,684.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$868.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$868.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$868.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,266.10
|
|
|
12044 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6-12.5cm
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
8037199
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$857.65 |
| Rate for Payer: AlohaCare Medicaid |
$220.92
|
| Rate for Payer: AlohaCare Medicare |
$194.42
|
| Rate for Payer: Cash Price |
$655.85
|
| Rate for Payer: Cash Price |
$655.85
|
| Rate for Payer: Cash Price |
$655.85
|
| Rate for Payer: Devoted Health Medicare |
$213.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$337.77
|
| 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 |
$190.32
|
| Rate for Payer: Health Management Network Commercial |
$857.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.30
|
| 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 |
$220.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.42
|
| 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 |
$249.95
|
|
|
12045-Neck/Hand/Feet/Genital 12.6-20.0 cm
|
Facility
|
IP
|
$3,028.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
8080024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,573.80 |
| Max. Negotiated Rate |
$2,937.16 |
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Health Management Network Commercial |
$2,573.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,725.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,937.16
|
|
|
12045-Neck/Hand/Feet/Genital 12.6-20.0 cm
|
Facility
|
OP
|
$3,028.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
8080024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,937.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,514.00
|
| Rate for Payer: AlohaCare Medicare |
$1,514.00
|
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Cash Price |
$1,968.20
|
| Rate for Payer: Devoted Health Medicare |
$1,665.40
|
| 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 |
$1,514.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,876.60
|
| Rate for Payer: Health Management Network Commercial |
$2,573.80
|
| Rate for Payer: Humana Medicare |
$1,514.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,725.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,514.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,937.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,514.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,514.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,514.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,207.11
|
|
