|
13121 Repair complex scalp arms and/or legs 2.6 cm to 7.5 cm
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
8037213
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,224.85 |
| Rate for Payer: AlohaCare Medicaid |
$264.70
|
| Rate for Payer: AlohaCare Medicare |
$218.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$240.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.30
|
| 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 |
$274.82
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.68
|
| 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 |
$264.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.90
|
| 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 |
$301.31
|
|
|
13121-Scalp/Arms/Legs 2.6-7.5 cm
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
8080033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,255.00
|
| Rate for Payer: AlohaCare Medicare |
$1,255.00
|
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Devoted Health Medicare |
$1,380.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,255.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,384.50
|
| Rate for Payer: Health Management Network Commercial |
$2,133.50
|
| Rate for Payer: Humana Medicare |
$1,255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,259.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,255.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,434.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,255.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,255.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,255.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
13121-Scalp/Arms/Legs 2.6-7.5 cm
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
8080033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,133.50 |
| Max. Negotiated Rate |
$2,434.70 |
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Health Management Network Commercial |
$2,133.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,259.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,434.70
|
|
|
13122 Repair complex scalp arms and/or legs each additional 5 cm or less
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
8037214
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.77 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$82.26
|
| Rate for Payer: AlohaCare Medicare |
$66.77
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Devoted Health Medicare |
$73.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.19
|
| 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 |
$90.48
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.12
|
| 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 |
$82.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.77
|
| 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 |
$94.86
|
|
|
13122-Scalp/Arms/Legs Each Addl 5 cm
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
8080035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.85 |
| Max. Negotiated Rate |
$602.37 |
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Health Management Network Commercial |
$527.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$558.90
|
| Rate for Payer: MDX Hawaii PPO |
$602.37
|
|
|
13122-Scalp/Arms/Legs Each Addl 5 cm
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
8080035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$310.50
|
| Rate for Payer: AlohaCare Medicare |
$310.50
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Devoted Health Medicare |
$341.55
|
| 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 |
$310.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$589.95
|
| Rate for Payer: Health Management Network Commercial |
$527.85
|
| Rate for Payer: Humana Medicare |
$310.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$558.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$310.50
|
| Rate for Payer: MDX Hawaii PPO |
$602.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.50
|
| Rate for Payer: University Health Alliance Commercial |
$452.65
|
|
|
13131-Face/Neck/Hand/Feet/Genital 1.1-2.5 cm
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
8080026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,943.10 |
| Max. Negotiated Rate |
$2,217.42 |
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Health Management Network Commercial |
$1,943.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,057.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,217.42
|
|
|
13131-Face/Neck/Hand/Feet/Genital 1.1-2.5 cm
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
8080026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,217.42 |
| Rate for Payer: AlohaCare Medicaid |
$1,143.00
|
| Rate for Payer: AlohaCare Medicare |
$1,143.00
|
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Devoted Health Medicare |
$1,257.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,143.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,171.70
|
| Rate for Payer: Health Management Network Commercial |
$1,943.10
|
| Rate for Payer: Humana Medicare |
$1,143.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,057.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,143.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,217.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,143.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,143.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,143.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,666.27
|
|
|
13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee
|
Facility
|
OP
|
$2,707.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
8022664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,625.79 |
| Rate for Payer: AlohaCare Medicaid |
$1,353.50
|
| Rate for Payer: AlohaCare Medicare |
$1,353.50
|
| Rate for Payer: Cash Price |
$1,759.55
|
| Rate for Payer: Cash Price |
$1,759.55
|
| Rate for Payer: Devoted Health Medicare |
$1,488.85
|
| 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 |
$1,353.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,571.65
|
| Rate for Payer: Health Management Network Commercial |
$2,300.95
|
| Rate for Payer: Humana Medicare |
$1,353.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,436.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,353.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,625.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,353.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,353.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,353.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,973.13
|
|
|
13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee
|
Facility
|
IP
|
$2,707.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
8022664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,300.95 |
| Max. Negotiated Rate |
$2,625.79 |
| Rate for Payer: Cash Price |
$1,759.55
|
| Rate for Payer: Health Management Network Commercial |
$2,300.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,436.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,625.79
|
|
|
13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 1.1-2.5cm
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
8037215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$889.10 |
| Rate for Payer: AlohaCare Medicaid |
$248.26
|
| Rate for Payer: AlohaCare Medicare |
$207.37
|
| Rate for Payer: Cash Price |
$679.90
|
| Rate for Payer: Cash Price |
$679.90
|
| Rate for Payer: Cash Price |
$679.90
|
| Rate for Payer: Devoted Health Medicare |
$228.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$382.94
|
| 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 |
$166.92
|
| Rate for Payer: Health Management Network Commercial |
$889.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.84
|
| 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 |
$248.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.37
|
| 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 |
$283.37
|
|
|
13132-Face/Neck/Hand/Feet/Genital 2.6-7.5 cm
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
8080028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,489.65 |
| Max. Negotiated Rate |
$2,841.13 |
| Rate for Payer: Cash Price |
$1,903.85
|
| Rate for Payer: Health Management Network Commercial |
$2,489.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,636.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,841.13
|
|
|
13132-Face/Neck/Hand/Feet/Genital 2.6-7.5 cm
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
8080028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,464.50
|
| Rate for Payer: AlohaCare Medicare |
$1,464.50
|
| Rate for Payer: Cash Price |
$1,903.85
|
| Rate for Payer: Cash Price |
$1,903.85
|
| Rate for Payer: Devoted Health Medicare |
$1,610.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,464.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,782.55
|
| Rate for Payer: Health Management Network Commercial |
$2,489.65
|
| Rate for Payer: Humana Medicare |
$1,464.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,636.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,464.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,841.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,464.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,464.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,464.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee
|
Facility
|
OP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
8022665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,780.50
|
| Rate for Payer: AlohaCare Medicare |
$1,780.50
|
| Rate for Payer: Cash Price |
$2,314.65
|
| Rate for Payer: Cash Price |
$2,314.65
|
| Rate for Payer: Devoted Health Medicare |
$1,958.55
|
| 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 |
$1,780.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,382.95
|
| Rate for Payer: Health Management Network Commercial |
$3,026.85
|
| Rate for Payer: Humana Medicare |
$1,780.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,204.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,780.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,454.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,780.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,780.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,780.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee
|
Facility
|
IP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
8022665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,026.85 |
| Max. Negotiated Rate |
$3,454.17 |
| Rate for Payer: Cash Price |
$2,314.65
|
| Rate for Payer: Health Management Network Commercial |
$3,026.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,204.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,454.17
|
|
|
13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 2.6-7.5cm
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
8037216
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,322.60 |
| Rate for Payer: AlohaCare Medicaid |
$309.75
|
| Rate for Payer: AlohaCare Medicare |
$254.76
|
| Rate for Payer: Cash Price |
$1,011.40
|
| Rate for Payer: Cash Price |
$1,011.40
|
| Rate for Payer: Cash Price |
$1,011.40
|
| Rate for Payer: Devoted Health Medicare |
$280.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$617.50
|
| 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 |
$401.96
|
| Rate for Payer: Health Management Network Commercial |
$1,322.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.71
|
| 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 |
$309.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$254.76
|
| 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 |
$353.92
|
|
|
13133-Face/Neck/Hand/Feet/Genital Each Addl 5 cm
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
8080030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.05 |
| Max. Negotiated Rate |
$730.41 |
| Rate for Payer: Cash Price |
$489.45
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.70
|
| Rate for Payer: MDX Hawaii PPO |
$730.41
|
|
|
13133-Face/Neck/Hand/Feet/Genital Each Addl 5 cm
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
8080030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$376.50
|
| Rate for Payer: AlohaCare Medicare |
$376.50
|
| Rate for Payer: Cash Price |
$489.45
|
| Rate for Payer: Cash Price |
$489.45
|
| Rate for Payer: Devoted Health Medicare |
$414.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$715.35
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Humana Medicare |
$376.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.50
|
| Rate for Payer: MDX Hawaii PPO |
$730.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$376.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.50
|
| Rate for Payer: University Health Alliance Commercial |
$548.86
|
|
|
13133 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; addl 5cm
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
8037217
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$101.38 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$125.74
|
| Rate for Payer: AlohaCare Medicare |
$101.38
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Cash Price |
$312.65
|
| Rate for Payer: Devoted Health Medicare |
$111.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$195.38
|
| 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 |
$132.86
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.66
|
| 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 |
$125.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.38
|
| 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 |
$144.58
|
|
|
13151-Eyes/Ears/Nose/Lip 1.1-2.5 cm
|
Facility
|
IP
|
$2,321.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
8080032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,972.85 |
| Max. Negotiated Rate |
$2,251.37 |
| Rate for Payer: Cash Price |
$1,508.65
|
| Rate for Payer: Health Management Network Commercial |
$1,972.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,088.90
|
| Rate for Payer: MDX Hawaii PPO |
$2,251.37
|
|
|
13151-Eyes/Ears/Nose/Lip 1.1-2.5 cm
|
Facility
|
OP
|
$2,321.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
8080032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,251.37 |
| Rate for Payer: AlohaCare Medicaid |
$1,160.50
|
| Rate for Payer: AlohaCare Medicare |
$1,160.50
|
| Rate for Payer: Cash Price |
$1,508.65
|
| Rate for Payer: Cash Price |
$1,508.65
|
| Rate for Payer: Devoted Health Medicare |
$1,276.55
|
| 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 |
$1,160.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,204.95
|
| Rate for Payer: Health Management Network Commercial |
$1,972.85
|
| Rate for Payer: Humana Medicare |
$1,160.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,088.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,160.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,251.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,160.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,160.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,160.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,691.78
|
|
|
13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM TechFee
|
Facility
|
IP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
8022668
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,338.35 |
| Max. Negotiated Rate |
$2,668.47 |
| Rate for Payer: Cash Price |
$1,788.15
|
| Rate for Payer: Health Management Network Commercial |
$2,338.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,475.90
|
| Rate for Payer: MDX Hawaii PPO |
$2,668.47
|
|
|
13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM TechFee
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
8022668
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,668.47 |
| Rate for Payer: AlohaCare Medicaid |
$1,375.50
|
| Rate for Payer: AlohaCare Medicare |
$1,375.50
|
| Rate for Payer: Cash Price |
$1,788.15
|
| Rate for Payer: Cash Price |
$1,788.15
|
| Rate for Payer: Devoted Health Medicare |
$1,513.05
|
| 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 |
$1,375.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,613.45
|
| Rate for Payer: Health Management Network Commercial |
$2,338.35
|
| Rate for Payer: Humana Medicare |
$1,375.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,475.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,375.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,668.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,375.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,375.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,375.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,005.20
|
|
|
13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
8037218
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,003.85 |
| Rate for Payer: AlohaCare Medicaid |
$284.59
|
| Rate for Payer: AlohaCare Medicare |
$236.40
|
| Rate for Payer: Cash Price |
$767.65
|
| Rate for Payer: Cash Price |
$767.65
|
| Rate for Payer: Cash Price |
$767.65
|
| Rate for Payer: Devoted Health Medicare |
$260.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$439.77
|
| 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 |
$282.62
|
| Rate for Payer: Health Management Network Commercial |
$1,003.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.68
|
| 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 |
$284.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.40
|
| 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 |
$325.43
|
|
|
13152-Eye/Ear/Nose/Lip 2.6-7.5 cm
|
Facility
|
OP
|
$3,227.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
8080034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,743.44 |
| 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 |
$6,743.44
|
|
