|
10160-Aspiration Abscess/Cyst/Hematoma
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8080053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$909.50 |
| Max. Negotiated Rate |
$1,037.90 |
| Rate for Payer: Cash Price |
$695.50
|
| Rate for Payer: Health Management Network Commercial |
$909.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$963.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,037.90
|
|
|
10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
8037072
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$101.97
|
| Rate for Payer: AlohaCare Medicare |
$95.49
|
| 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 |
$105.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$153.51
|
| 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 |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.59
|
| 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 |
$101.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.49
|
| 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 |
$110.81
|
|
|
10180 Incision and drainage, complex, postoperative wound infection
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
8037073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$198.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$184.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
10180 Incision and drainage, complex, postoperative wound infection
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
8037073
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$198.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.06
|
| 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 |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.23
|
| 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 |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8022547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,334.50 |
| Max. Negotiated Rate |
$1,522.90 |
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Health Management Network Commercial |
$1,334.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,522.90
|
|
|
11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8022547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$785.00
|
| Rate for Payer: AlohaCare Medicare |
$785.00
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Devoted Health Medicare |
$863.50
|
| 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 |
$785.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,491.50
|
| Rate for Payer: Health Management Network Commercial |
$1,334.50
|
| Rate for Payer: Humana Medicare |
$785.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$785.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,522.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$785.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$785.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$785.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,144.37
|
|
|
11000 Debridement of extensive eczematous or infected skin up to 10% of body surface
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8037074
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: AlohaCare Medicaid |
$27.41
|
| Rate for Payer: AlohaCare Medicare |
$24.09
|
| 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 |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.71
|
| 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 |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$481.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.91
|
| 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 |
$27.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.09
|
| 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
|
|
|
11000-Extensive Eczematous/Infected Skin Less Than 10%
|
Facility
|
OP
|
$1,376.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8080152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$688.00
|
| Rate for Payer: AlohaCare Medicare |
$688.00
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Devoted Health Medicare |
$756.80
|
| 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 |
$688.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,307.20
|
| Rate for Payer: Health Management Network Commercial |
$1,169.60
|
| Rate for Payer: Humana Medicare |
$688.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$688.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,334.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$688.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$688.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$688.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,002.97
|
|
|
11000-Extensive Eczematous/Infected Skin Less Than 10%
|
Facility
|
IP
|
$1,376.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
8080152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,169.60 |
| Max. Negotiated Rate |
$1,334.72 |
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Health Management Network Commercial |
$1,169.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,238.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,334.72
|
|
|
11001 Debridement of extensive eczematous or infected skin; up to 10% of body surface, or part there
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8037075
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$14.75
|
| Rate for Payer: AlohaCare Medicare |
$12.55
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$13.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.87
|
| 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 Medicare |
$237.64
|
| 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 |
$181.39
|
| 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 |
$21.84
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.06
|
| 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 |
$303.73
|
| 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 |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.55
|
| 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
|
|
|
11001-Extensive Eczematous/Infected Skin Each Additional 10%
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8080153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.65 |
| Max. Negotiated Rate |
$202.73 |
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Health Management Network Commercial |
$177.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.10
|
| Rate for Payer: MDX Hawaii PPO |
$202.73
|
|
|
11001-Extensive Eczematous/Infected Skin Each Additional 10%
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
8080153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$104.50
|
| Rate for Payer: AlohaCare Medicare |
$104.50
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Devoted Health Medicare |
$114.95
|
| 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 |
$104.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.55
|
| Rate for Payer: Health Management Network Commercial |
$177.65
|
| Rate for Payer: Humana Medicare |
$104.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$188.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.50
|
| Rate for Payer: MDX Hawaii PPO |
$202.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.50
|
| Rate for Payer: University Health Alliance Commercial |
$152.34
|
|
|
11004 Debride of skin, subQ tissue, muscle and fascia for necrotizing soft tissue infection
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
8037076
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,356.60 |
| Rate for Payer: AlohaCare Medicaid |
$549.81
|
| Rate for Payer: AlohaCare Medicare |
$486.13
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Devoted Health Medicare |
$534.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$535.60
|
| Rate for Payer: Health Management Network Commercial |
$1,356.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.36
|
| 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 |
$303.73
|
| 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 |
$549.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.13
|
| 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 |
$800.00
|
|
|
11005 Debride of skin, subQ tissue, muscle/fascia for necrotizing soft tissue infection; abd wall
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
8037077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,805.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$791.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.83
|
| Rate for Payer: University Health Alliance Commercial |
$1,026.00
|
|
|
11005 Debride of skin, subQ tissue, muscle/fascia for necrotizing soft tissue infection; abd wall
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
8037077
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,805.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.80
|
| 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 |
$303.73
|
| 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 |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| 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 |
$1,026.00
|
|
|
11006 Debride of soft tissue infect; ext genitalia, perineum and abd wall, w/ or w/o fascial closure
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 11006
|
| Hospital Charge Code |
8037078
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: AlohaCare Medicaid |
$673.84
|
| Rate for Payer: AlohaCare Medicare |
$598.41
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Devoted Health Medicare |
$658.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$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 Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.09
|
| 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 |
$303.73
|
| 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 |
$673.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| 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 |
$181.39
|
| 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 |
$800.00
|
|
|
11008 Removal of prosthetic material or mesh, abdominal wall for infection
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
8037079
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: AlohaCare Medicaid |
$260.16
|
| Rate for Payer: AlohaCare Medicare |
$232.36
|
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Devoted Health Medicare |
$255.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 Medicare |
$237.64
|
| 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 |
$181.39
|
| 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 |
$260.78
|
| Rate for Payer: Health Management Network Commercial |
$634.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.83
|
| 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 |
$303.73
|
| 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 |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.36
|
| 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
|
|
|
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8022551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.00 |
| Max. Negotiated Rate |
$1,571.40 |
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Health Management Network Commercial |
$1,377.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,458.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,571.40
|
|
|
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8022551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$810.00
|
| Rate for Payer: AlohaCare Medicare |
$810.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Devoted Health Medicare |
$891.00
|
| 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 |
$810.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,539.00
|
| Rate for Payer: Health Management Network Commercial |
$1,377.00
|
| Rate for Payer: Humana Medicare |
$810.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,458.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,571.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$810.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$810.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$810.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,180.82
|
|
|
11010 Debridement Open Fx/Dislocation; Skin and SubQ Tissues
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8037080
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,190.85 |
| Rate for Payer: AlohaCare Medicaid |
$280.66
|
| Rate for Payer: AlohaCare Medicare |
$250.99
|
| Rate for Payer: Cash Price |
$910.65
|
| Rate for Payer: Cash Price |
$910.65
|
| Rate for Payer: Cash Price |
$910.65
|
| Rate for Payer: Devoted Health Medicare |
$276.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.99
|
| 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 |
$308.36
|
| Rate for Payer: Health Management Network Commercial |
$1,190.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.19
|
| 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 |
$280.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.99
|
| 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 |
$321.89
|
|
|
11010-FB Skin/Subsequent of Open Fracture/Dislocation Site
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8080154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$708.00
|
| Rate for Payer: AlohaCare Medicare |
$708.00
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Devoted Health Medicare |
$778.80
|
| 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 |
$708.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,345.20
|
| Rate for Payer: Health Management Network Commercial |
$1,203.60
|
| Rate for Payer: Humana Medicare |
$708.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,274.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$708.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,373.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$708.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$708.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$708.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,032.12
|
|
|
11010-FB Skin/Subsequent of Open Fracture/Dislocation Site
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
8080154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.60 |
| Max. Negotiated Rate |
$1,373.52 |
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Health Management Network Commercial |
$1,203.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,274.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,373.52
|
|
|
11011 Debridement Open Fx/Dislocation; to Muscle
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
8037081
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$1,297.10 |
| Rate for Payer: AlohaCare Medicaid |
$296.15
|
| Rate for Payer: AlohaCare Medicare |
$261.39
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Devoted Health Medicare |
$287.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$460.79
|
| 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 |
$373.10
|
| Rate for Payer: Health Management Network Commercial |
$1,297.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.67
|
| 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 |
$296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.39
|
| 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 |
$500.00
|
|
|
11012 AS Debride Skin/Muscle/Bone, FX
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
HCPCS 11012
|
| Hospital Charge Code |
4122425
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: AlohaCare Medicaid |
$413.97
|
| Rate for Payer: AlohaCare Medicare |
$356.79
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Cash Price |
$2,627.95
|
| Rate for Payer: Devoted Health Medicare |
$392.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$646.49
|
| 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 |
$520.26
|
| Rate for Payer: Health Management Network Commercial |
$3,436.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$428.15
|
| 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 |
$413.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.79
|
| 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 |
$800.00
|
|
|
11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
8022554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$763.00
|
| Rate for Payer: AlohaCare Medicare |
$763.00
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Devoted Health Medicare |
$839.30
|
| 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 |
$763.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,449.70
|
| Rate for Payer: Health Management Network Commercial |
$1,297.10
|
| Rate for Payer: Humana Medicare |
$763.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,373.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$763.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,480.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$763.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$763.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
