|
12045 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6-20.0cm
|
Professional
|
Both
|
$1,074.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
8037200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$174.46 |
| Max. Negotiated Rate |
$912.90 |
| Rate for Payer: AlohaCare Medicaid |
$282.29
|
| Rate for Payer: AlohaCare Medicare |
$275.54
|
| Rate for Payer: Cash Price |
$698.10
|
| Rate for Payer: Cash Price |
$698.10
|
| Rate for Payer: Cash Price |
$698.10
|
| Rate for Payer: Devoted Health Medicare |
$303.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$419.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.46
|
| Rate for Payer: Health Management Network Commercial |
$912.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.65
|
| 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 |
$282.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.54
|
| 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 |
$319.52
|
|
|
12046-Neck/Hand/Feet/Genital 20.1-30.0 cm
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
8080007
|
|
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
|
|
|
12046-Neck/Hand/Feet/Genital 20.1-30.0 cm
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
8080007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$992.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,446.14
|
|
|
12046 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1-30.0cm
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
8037201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,082.05 |
| Rate for Payer: AlohaCare Medicaid |
$323.16
|
| Rate for Payer: AlohaCare Medicare |
$316.18
|
| Rate for Payer: Cash Price |
$827.45
|
| Rate for Payer: Cash Price |
$827.45
|
| Rate for Payer: Cash Price |
$827.45
|
| Rate for Payer: Devoted Health Medicare |
$347.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$482.16
|
| 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 |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$1,082.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.42
|
| 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 |
$323.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.18
|
| 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 |
$351.47
|
|
|
12047-Neck/Hand/Feet/Genital Greater Than 30.0 cm
|
Facility
|
IP
|
$8,091.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
8080009
|
|
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
|
|
|
12047-Neck/Hand/Feet/Genital Greater Than 30.0 cm
|
Facility
|
OP
|
$8,091.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
8080009
|
|
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
|
|
|
12051-Face/Ear/Eye/Nose/Lip Less Than/Equal to 2.5 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8080011
|
|
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
|
|
|
12051-Face/Ear/Eye/Nose/Lip Less Than/Equal to 2.5 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8080011
|
|
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
|
|
|
12051 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; <2.5cm
|
Professional
|
Both
|
$973.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8037202
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$827.05 |
| Rate for Payer: AlohaCare Medicaid |
$176.67
|
| Rate for Payer: AlohaCare Medicare |
$153.96
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Cash Price |
$632.45
|
| Rate for Payer: Devoted Health Medicare |
$169.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$269.97
|
| 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 |
$144.82
|
| Rate for Payer: Health Management Network Commercial |
$827.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$191.81
|
|
|
12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8022651
|
|
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
|
|
|
12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
8022651
|
|
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
|
|
|
12052-Face/Ear/Eye/Nose/Lip 2.6-5.0 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8080013
|
|
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
|
|
|
12052-Face/Ear/Eye/Nose/Lip 2.6-5.0 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8080013
|
|
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
|
|
|
12052 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8037203
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: AlohaCare Medicaid |
$207.25
|
| Rate for Payer: AlohaCare Medicare |
$177.19
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Devoted Health Medicare |
$194.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$316.65
|
| 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 |
$170.56
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.19
|
| 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 |
$225.61
|
|
|
12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8022652
|
|
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
|
|
|
12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
8022652
|
|
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
|
|
|
12053-Face/Ear/Eye/Nose/Lip 5.1-7.5 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
8080015
|
|
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
|
|
|
12053-Face/Ear/Eye/Nose/Lip 5.1-7.5 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
8080015
|
|
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
|
|
|
12053 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 5.1-7.5cm
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
8037204
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$844.05 |
| Rate for Payer: AlohaCare Medicaid |
$222.76
|
| Rate for Payer: AlohaCare Medicare |
$191.26
|
| Rate for Payer: Cash Price |
$645.45
|
| Rate for Payer: Cash Price |
$645.45
|
| Rate for Payer: Cash Price |
$645.45
|
| Rate for Payer: Devoted Health Medicare |
$210.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$339.81
|
| 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 |
$193.44
|
| Rate for Payer: Health Management Network Commercial |
$844.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.51
|
| 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 |
$222.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.26
|
| 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 |
$242.55
|
|
|
12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
8022653
|
|
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
|
|
|
12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
8022653
|
|
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
|
|
|
12054-Face/Ear/Eye/Nose/Lip 7.6-12.5 cm
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8080017
|
|
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
|
|
|
12054-Face/Ear/Eye/Nose/Lip 7.6-12.5 cm
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8080017
|
|
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
|
|
|
12054 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 7.6-12.5cm
|
Professional
|
Both
|
$1,049.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8037205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$891.65 |
| Rate for Payer: AlohaCare Medicaid |
$224.51
|
| Rate for Payer: AlohaCare Medicare |
$198.95
|
| Rate for Payer: Cash Price |
$681.85
|
| Rate for Payer: Cash Price |
$681.85
|
| Rate for Payer: Cash Price |
$681.85
|
| Rate for Payer: Devoted Health Medicare |
$218.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$342.56
|
| 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 |
$237.64
|
| Rate for Payer: Health Management Network Commercial |
$891.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.74
|
| 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 |
$224.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.95
|
| 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 |
$253.49
|
|
|
12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
8022654
|
|
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
|
|
