|
10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8022539
|
|
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
|
|
|
10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
8022539
|
|
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
|
|
|
10080-I&D Pilonidal Cyst Simple
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
8080047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
10080-I&D Pilonidal Cyst Simple
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
8080047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,812.50
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| 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 |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
10080 Incision and drainage of pilonidal cyst; simple
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
8037067
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: AlohaCare Medicaid |
$111.66
|
| Rate for Payer: AlohaCare Medicare |
$110.45
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$168.65
|
| 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 |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.54
|
| 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 |
$111.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.45
|
| 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 |
$120.86
|
|
|
10081-I&D Pilonidal Cyst Complicated
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
8080049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,081.25 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
|
|
10081-I&D Pilonidal Cyst Complicated
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
8080049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,516.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,812.50
|
| Rate for Payer: AlohaCare Medicare |
$1,812.50
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Cash Price |
$2,356.25
|
| Rate for Payer: Devoted Health Medicare |
$1,993.75
|
| 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 |
$1,812.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,443.75
|
| Rate for Payer: Health Management Network Commercial |
$3,081.25
|
| Rate for Payer: Humana Medicare |
$1,812.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,262.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,812.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,516.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,812.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,812.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,812.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,642.26
|
|
|
10081 Incision and drainage of pilonidal cyst; complicated
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
8037068
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: AlohaCare Medicaid |
$175.37
|
| Rate for Payer: AlohaCare Medicare |
$171.67
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Cash Price |
$642.20
|
| Rate for Payer: Devoted Health Medicare |
$188.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$272.42
|
| 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 |
$111.54
|
| Rate for Payer: Health Management Network Commercial |
$839.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.00
|
| 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 |
$175.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.67
|
| 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 |
$201.59
|
|
|
10120 Incision and removal of foreign body, subcutaneous tissues; simple
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8037069
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: AlohaCare Medicaid |
$113.02
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Devoted Health Medicare |
$118.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.25
|
| 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 |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| 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 |
$113.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| 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 |
$125.09
|
|
|
10120 Incision and removal of foreign body, subcutaneous tissues; simple
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8037069
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: AlohaCare Medicaid |
$113.02
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Cash Price |
$339.95
|
| Rate for Payer: Devoted Health Medicare |
$118.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.15
|
| Rate for Payer: University Health Alliance Commercial |
$125.09
|
|
|
10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8022542
|
|
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
|
|
|
10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8022542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$440.00
|
| Rate for Payer: AlohaCare Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Devoted Health Medicare |
$484.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$836.00
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Humana Medicare |
$440.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.00
|
| Rate for Payer: MDX Hawaii PPO |
$853.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$440.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
10120-Subcutaneous Tissue Simple
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8080135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$405.00
|
| Rate for Payer: AlohaCare Medicare |
$405.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Devoted Health Medicare |
$445.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$769.50
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Humana Medicare |
$405.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
10120-Subcutaneous Tissue Simple
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
8080135
|
|
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
|
|
|
10121 Incision and removal of foreign body, subcutaneous tissues; complicated
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8037070
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$189.71
|
| Rate for Payer: AlohaCare Medicare |
$175.90
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$193.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.59
|
| 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 |
$151.06
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.08
|
| 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 |
$189.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.90
|
| 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 |
$216.52
|
|
|
10121 Incision and removal of foreign body, subcutaneous tissues; complicated
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8037070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$189.71
|
| Rate for Payer: AlohaCare Medicare |
$175.90
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$193.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$189.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$189.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.06
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.90
|
| Rate for Payer: University Health Alliance Commercial |
$216.52
|
|
|
10121-Subcutaneous Tissue Complex
|
Facility
|
OP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8080137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: AlohaCare Medicaid |
$3,624.50
|
| Rate for Payer: AlohaCare Medicare |
$3,624.50
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Devoted Health Medicare |
$3,986.95
|
| 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 |
$3,624.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,886.55
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Humana Medicare |
$3,624.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,624.50
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,624.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,624.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,624.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
10121-Subcutaneous Tissue Complex
|
Facility
|
IP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
8080137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,161.65 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
|
|
10140-I&D Hematoma/Seroma/Fluid
|
Facility
|
OP
|
$5,584.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8080051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,416.48 |
| Rate for Payer: AlohaCare Medicaid |
$2,792.00
|
| Rate for Payer: AlohaCare Medicare |
$2,792.00
|
| Rate for Payer: Cash Price |
$3,629.60
|
| Rate for Payer: Cash Price |
$3,629.60
|
| Rate for Payer: Devoted Health Medicare |
$3,071.20
|
| 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 |
$2,792.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,304.80
|
| Rate for Payer: Health Management Network Commercial |
$4,746.40
|
| Rate for Payer: Humana Medicare |
$2,792.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,025.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,792.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,416.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,792.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,792.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,792.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
10140-I&D Hematoma/Seroma/Fluid
|
Facility
|
IP
|
$5,584.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8080051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,746.40 |
| Max. Negotiated Rate |
$5,416.48 |
| Rate for Payer: Cash Price |
$3,629.60
|
| Rate for Payer: Health Management Network Commercial |
$4,746.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,025.60
|
| Rate for Payer: MDX Hawaii PPO |
$5,416.48
|
|
|
10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee
|
Facility
|
IP
|
$6,830.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8022544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,805.50 |
| Max. Negotiated Rate |
$6,625.10 |
| Rate for Payer: Cash Price |
$4,439.50
|
| Rate for Payer: Health Management Network Commercial |
$5,805.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,147.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,625.10
|
|
|
10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee
|
Facility
|
OP
|
$6,830.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8022544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,625.10 |
| Rate for Payer: AlohaCare Medicaid |
$3,415.00
|
| Rate for Payer: AlohaCare Medicare |
$3,415.00
|
| Rate for Payer: Cash Price |
$4,439.50
|
| Rate for Payer: Cash Price |
$4,439.50
|
| Rate for Payer: Devoted Health Medicare |
$3,756.50
|
| 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 |
$3,415.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,488.50
|
| Rate for Payer: Health Management Network Commercial |
$5,805.50
|
| Rate for Payer: Humana Medicare |
$3,415.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,147.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,415.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,625.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,415.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,415.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,415.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
10140 Incision and drainage of hematoma, seroma or fluid collection
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8037071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: AlohaCare Medicaid |
$124.60
|
| Rate for Payer: AlohaCare Medicare |
$120.44
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Devoted Health Medicare |
$132.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.44
|
| Rate for Payer: University Health Alliance Commercial |
$140.50
|
|
|
10140 Incision and drainage of hematoma, seroma or fluid collection
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
8037071
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$124.60
|
| Rate for Payer: AlohaCare Medicare |
$120.44
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$132.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.87
|
| 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 |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.53
|
| 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 |
$124.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.44
|
| 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 |
$140.50
|
|
|
10160-Aspiration Abscess/Cyst/Hematoma
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8080053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$535.00
|
| Rate for Payer: AlohaCare Medicare |
$535.00
|
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Devoted Health Medicare |
$588.50
|
| 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 |
$535.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,016.50
|
| Rate for Payer: Health Management Network Commercial |
$909.50
|
| Rate for Payer: Humana Medicare |
$535.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$963.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$535.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,037.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$535.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$535.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$535.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
