|
97597-Devitalized Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8080159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
|
|
97597-Devitalized Tissue Less Than/Equal to 1st 20 sq cm
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
8080159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$300.00
|
| Rate for Payer: AlohaCare Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$330.00
|
| 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 |
$300.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Humana Medicare |
$300.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.00
|
| Rate for Payer: University Health Alliance Commercial |
$437.34
|
|
|
97598 Debridement, open wound; each additional 20 sq cm, or part thereof
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8040895
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.27
|
| Rate for Payer: AlohaCare Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Devoted Health Medicare |
$23.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$72.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.18
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.58
|
| 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 |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
|
|
97598 Debridement, open wound; each additional 20 sq cm, or part thereof
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
8040895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$202.30 |
| Rate for Payer: AlohaCare Medicaid |
$24.27
|
| Rate for Payer: AlohaCare Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$23.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$72.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.18
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.32
|
|
|
97598 Debride Select Ea Addl 20cm Charges
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
8221487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: AlohaCare Medicaid |
$137.50
|
| Rate for Payer: AlohaCare Medicare |
$137.50
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$151.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$137.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.50
|
| Rate for Payer: University Health Alliance Commercial |
$154.00
|
|
|
97598 Debride Select Ea Addl 20cm Charges
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598 GP
|
| Hospital Charge Code |
8221487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
97598-Devitalized Tissue, Each Additional 20 sq cm
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9394270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$137.50
|
| Rate for Payer: AlohaCare Medicare |
$137.50
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$151.25
|
| 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 |
$137.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$137.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.50
|
| Rate for Payer: University Health Alliance Commercial |
$200.45
|
|
|
97598-Devitalized Tissue, Each Additional 20 sq cm
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9394270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
97602 ACTIVE WOUND CARE MANAGEMENT TechFee
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8258868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$476.27 |
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
|
|
97602 ACTIVE WOUND CARE MANAGEMENT TechFee
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8258868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$245.50
|
| Rate for Payer: AlohaCare Medicare |
$245.50
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Devoted Health Medicare |
$270.05
|
| 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 |
$245.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$466.45
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Humana Medicare |
$245.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.50
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.50
|
| Rate for Payer: University Health Alliance Commercial |
$357.89
|
|
|
97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8040896
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$237.15 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.31
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.46
|
|
|
97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
8040896
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.31
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
97605 Negative pressure wound therapy; total wound(s) surface area less than or equal to 50 sq cm
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8040897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: AlohaCare Medicaid |
$24.61
|
| Rate for Payer: AlohaCare Medicare |
$21.27
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$23.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.67
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.27
|
| Rate for Payer: University Health Alliance Commercial |
$30.44
|
|
|
97605 Negative pressure wound therapy; total wound(s) surface area less than or equal to 50 sq cm
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8040897
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$24.61
|
| Rate for Payer: AlohaCare Medicare |
$21.27
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Devoted Health Medicare |
$23.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.67
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.52
|
| 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 |
$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 |
$24.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$30.44
|
|
|
97605 Neg Press Wound Tx < 50 CM Charges
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8221507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
|
|
97605 Neg Press Wound Tx < 50 CM Charges
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
8221507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$384.12 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicare |
$198.00
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$217.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$256.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$376.20
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Humana Medicare |
$198.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.00
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.00
|
| Rate for Payer: University Health Alliance Commercial |
$221.76
|
|
|
97606 Negative pressure wound therapy; total wound(s) surface area greater than 50 sq cm
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
8040898
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$27.04
|
| Rate for Payer: AlohaCare Medicare |
$23.32
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$25.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.63
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.98
|
| 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 |
$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 |
$27.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$33.42
|
|
|
97606 Negative pressure wound therapy; total wound(s) surface area greater than 50 sq cm
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
8040898
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$27.04
|
| Rate for Payer: AlohaCare Medicare |
$23.32
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$25.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.63
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.32
|
| Rate for Payer: University Health Alliance Commercial |
$33.42
|
|
|
97606 Neg Press Wound Tx > 50 CM Charges
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
8221532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$790.55 |
| Rate for Payer: AlohaCare Medicaid |
$407.50
|
| Rate for Payer: AlohaCare Medicare |
$407.50
|
| Rate for Payer: Cash Price |
$529.75
|
| Rate for Payer: Cash Price |
$529.75
|
| Rate for Payer: Devoted Health Medicare |
$448.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$407.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$774.25
|
| Rate for Payer: Health Management Network Commercial |
$692.75
|
| Rate for Payer: Humana Medicare |
$407.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$733.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$415.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.50
|
| Rate for Payer: MDX Hawaii PPO |
$790.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$407.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$407.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$407.50
|
| Rate for Payer: University Health Alliance Commercial |
$456.40
|
|
|
97606 Neg Press Wound Tx > 50 CM Charges
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
8221532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.75 |
| Max. Negotiated Rate |
$790.55 |
| Rate for Payer: Cash Price |
$529.75
|
| Rate for Payer: Health Management Network Commercial |
$692.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$733.50
|
| Rate for Payer: MDX Hawaii PPO |
$790.55
|
|
|
97607 NEG PRESS WND TX <=50 SQ CM W/VIA ProFee
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
8022381
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$20.89
|
| Rate for Payer: AlohaCare Medicare |
$18.32
|
| Rate for Payer: Cash Price |
$317.20
|
| Rate for Payer: Cash Price |
$317.20
|
| Rate for Payer: Cash Price |
$317.20
|
| Rate for Payer: Devoted Health Medicare |
$20.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.19
|
| 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 |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network Commercial |
$414.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: University Health Alliance Commercial |
$23.97
|
|
|
97607 NEG PRESS WND TX <=50 SQ CM W/VIA ProFee
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
8022381
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$20.89
|
| Rate for Payer: AlohaCare Medicare |
$18.32
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Devoted Health Medicare |
$20.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.32
|
| Rate for Payer: University Health Alliance Commercial |
$23.97
|
|
|
97607 Neg Pre Wound <50 Sq Cm
|
Facility
|
IP
|
$1,541.00
|
|
|
Service Code
|
HCPCS 97607 GP,CQ
|
| Hospital Charge Code |
8222662
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1,309.85 |
| Max. Negotiated Rate |
$1,494.77 |
| Rate for Payer: Cash Price |
$1,001.65
|
| Rate for Payer: Health Management Network Commercial |
$1,309.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,386.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,494.77
|
|
|
97607 Neg Pre Wound <50 Sq Cm
|
Facility
|
OP
|
$1,541.00
|
|
|
Service Code
|
HCPCS 97607 GP,CQ
|
| Hospital Charge Code |
8222662
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$1,494.77 |
| Rate for Payer: AlohaCare Medicaid |
$770.50
|
| Rate for Payer: AlohaCare Medicare |
$770.50
|
| Rate for Payer: Cash Price |
$1,001.65
|
| Rate for Payer: Cash Price |
$1,001.65
|
| Rate for Payer: Devoted Health Medicare |
$847.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$770.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,463.95
|
| Rate for Payer: Health Management Network Commercial |
$1,309.85
|
| Rate for Payer: Humana Medicare |
$770.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,386.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$785.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$770.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,494.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$770.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$770.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$770.50
|
| Rate for Payer: University Health Alliance Commercial |
$862.96
|
|
|
97607 Neg Pre Wound <50 Sq Cm
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 97607 GP,CQ
|
| Hospital Charge Code |
8222662
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$20.89
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Cash Price |
$367.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$35.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.89
|
| Rate for Payer: University Health Alliance Commercial |
$23.97
|
|
