|
PROPYLTHIOURACIL 50 MG TABLET [6662]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 67253065110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,862.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$615.42 |
| Max. Negotiated Rate |
$1,582.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,110.01
|
| Rate for Payer: AlohaCare Medicare |
$969.45
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Devoted Health Medicare |
$1,066.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$969.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$615.42
|
| Rate for Payer: Health Management Network Commercial |
$1,582.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,163.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,163.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,163.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,110.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$969.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,110.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$969.45
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$475.14 |
| Max. Negotiated Rate |
$760.75 |
| Rate for Payer: AlohaCare Medicaid |
$522.09
|
| Rate for Payer: AlohaCare Medicare |
$475.14
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Devoted Health Medicare |
$522.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.70
|
| Rate for Payer: Health Management Network Commercial |
$760.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$570.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$570.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$522.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$522.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.14
|
| Rate for Payer: University Health Alliance Commercial |
$678.15
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$310.22 |
| Max. Negotiated Rate |
$492.15 |
| Rate for Payer: AlohaCare Medicaid |
$337.89
|
| Rate for Payer: AlohaCare Medicare |
$310.22
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Devoted Health Medicare |
$341.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$396.50
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$337.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$337.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.22
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$554.84 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: AlohaCare Medicaid |
$724.99
|
| Rate for Payer: AlohaCare Medicare |
$652.77
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Devoted Health Medicare |
$718.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.84
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$783.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$783.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$783.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$724.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$724.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.77
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: AlohaCare Medicaid |
$435.85
|
| Rate for Payer: AlohaCare Medicare |
$393.67
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Devoted Health Medicare |
$433.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$543.66
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.67
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$30,175.42
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$19,896.98 |
| Max. Negotiated Rate |
$30,175.42 |
| Rate for Payer: AlohaCare Medicare |
$19,896.98
|
| Rate for Payer: Devoted Health Medicare |
$21,886.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23,101.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19,896.98
|
| Rate for Payer: Humana Medicare |
$19,896.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$30,175.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$19,896.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$19,896.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$19,896.98
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$53,840.70
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$23,101.23 |
| Max. Negotiated Rate |
$53,840.70 |
| Rate for Payer: AlohaCare Medicare |
$35,501.34
|
| Rate for Payer: Devoted Health Medicare |
$39,051.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23,101.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35,501.34
|
| Rate for Payer: Humana Medicare |
$35,501.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$53,840.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$35,501.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$35,501.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$35,501.34
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$19,081.95
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$12,582.21 |
| Max. Negotiated Rate |
$19,081.95 |
| Rate for Payer: AlohaCare Medicare |
$12,582.21
|
| Rate for Payer: Devoted Health Medicare |
$13,840.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16,306.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,582.21
|
| Rate for Payer: Humana Medicare |
$12,582.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$19,081.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,582.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,582.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,582.21
|
|
|
PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Professional
|
Both
|
$882.93
|
|
|
Service Code
|
HCPCS 28111
|
| Min. Negotiated Rate |
$310.47 |
| Max. Negotiated Rate |
$750.49 |
| Rate for Payer: AlohaCare Medicaid |
$332.98
|
| Rate for Payer: AlohaCare Medicare |
$310.47
|
| Rate for Payer: Cash Price |
$529.76
|
| Rate for Payer: Cash Price |
$529.76
|
| Rate for Payer: Devoted Health Medicare |
$341.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$332.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$550.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$310.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$332.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$315.90
|
| Rate for Payer: Health Management Network Commercial |
$750.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$310.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$310.47
|
| Rate for Payer: University Health Alliance Commercial |
$433.60
|
|
|
PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4
|
Professional
|
Both
|
$907.58
|
|
|
Service Code
|
HCPCS 28112
|
| Min. Negotiated Rate |
$270.66 |
| Max. Negotiated Rate |
$771.44 |
| Rate for Payer: AlohaCare Medicaid |
$330.22
|
| Rate for Payer: AlohaCare Medicare |
$307.84
|
| Rate for Payer: Cash Price |
$544.55
|
| Rate for Payer: Cash Price |
$544.55
|
| Rate for Payer: Devoted Health Medicare |
$338.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$330.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$538.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$330.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$270.66
|
| Rate for Payer: Health Management Network Commercial |
$771.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$369.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$330.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$330.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.84
|
| Rate for Payer: University Health Alliance Commercial |
$412.24
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS
|
Professional
|
Both
|
$59.88
|
|
|
Service Code
|
HCPCS 98925
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$50.90 |
| Rate for Payer: AlohaCare Medicaid |
$23.14
|
| Rate for Payer: AlohaCare Medicare |
$19.79
|
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Devoted Health Medicare |
$21.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$50.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.79
|
| Rate for Payer: University Health Alliance Commercial |
$24.53
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS
|
Professional
|
Both
|
$84.89
|
|
|
Service Code
|
HCPCS 98926
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$72.16 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$29.90
|
| Rate for Payer: Cash Price |
$50.93
|
| Rate for Payer: Cash Price |
$50.93
|
| Rate for Payer: Devoted Health Medicare |
$32.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.43
|
| Rate for Payer: Health Management Network Commercial |
$72.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.90
|
| Rate for Payer: University Health Alliance Commercial |
$38.09
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS
|
Professional
|
Both
|
$111.48
|
|
|
Service Code
|
HCPCS 98927
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: AlohaCare Medicaid |
$46.66
|
| Rate for Payer: AlohaCare Medicare |
$40.15
|
| Rate for Payer: Cash Price |
$66.89
|
| Rate for Payer: Cash Price |
$66.89
|
| Rate for Payer: Devoted Health Medicare |
$44.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.61
|
| Rate for Payer: Health Management Network Commercial |
$94.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.15
|
| Rate for Payer: University Health Alliance Commercial |
$38.09
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS
|
Professional
|
Both
|
$134.47
|
|
|
Service Code
|
HCPCS 98928
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: AlohaCare Medicaid |
$58.80
|
| Rate for Payer: AlohaCare Medicare |
$50.26
|
| Rate for Payer: Cash Price |
$80.68
|
| Rate for Payer: Cash Price |
$80.68
|
| Rate for Payer: Devoted Health Medicare |
$55.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.25
|
| Rate for Payer: Health Management Network Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.26
|
| Rate for Payer: University Health Alliance Commercial |
$50.05
|
|
|
PR OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 27165
|
| Min. Negotiated Rate |
$1,031.42 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,398.91
|
| Rate for Payer: AlohaCare Medicare |
$1,263.13
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Devoted Health Medicare |
$1,389.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,263.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,031.42
|
| Rate for Payer: Health Management Network Commercial |
$2,036.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,515.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,515.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,515.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,398.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,263.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,398.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,263.13
|
|
|
PR OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 27454
|
| Min. Negotiated Rate |
$1,004.38 |
| Max. Negotiated Rate |
$1,924.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,318.67
|
| Rate for Payer: AlohaCare Medicare |
$1,183.54
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,183.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.38
|
| Rate for Payer: Health Management Network Commercial |
$1,924.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,420.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,420.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,420.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,318.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,183.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,318.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,183.54
|
|
|
PR OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 23480
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,238.45 |
| Rate for Payer: AlohaCare Medicaid |
$848.35
|
| Rate for Payer: AlohaCare Medicare |
$772.32
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Devoted Health Medicare |
$849.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$772.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$546.00
|
| Rate for Payer: Health Management Network Commercial |
$1,238.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$926.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$926.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$926.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$848.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$772.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$848.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$772.32
|
|
|
PR OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 23485
|
| Min. Negotiated Rate |
$752.44 |
| Max. Negotiated Rate |
$1,428.00 |
| Rate for Payer: AlohaCare Medicaid |
$979.44
|
| Rate for Payer: AlohaCare Medicare |
$877.33
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Devoted Health Medicare |
$965.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$877.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$752.44
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,052.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,052.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,052.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$979.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$877.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$979.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$877.33
|
|
|
PR OSTEOTOMY FIBULA
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 27707
|
| Min. Negotiated Rate |
$295.36 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$433.33
|
| Rate for Payer: AlohaCare Medicare |
$408.32
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$449.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$295.36
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$489.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$433.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$433.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.32
|
|
|
PR OSTEOTOMY METACARPAL EACH
|
Professional
|
Both
|
$1,307.00
|
|
|
Service Code
|
HCPCS 26565
|
| Min. Negotiated Rate |
$426.92 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: AlohaCare Medicaid |
$767.19
|
| Rate for Payer: AlohaCare Medicare |
$729.72
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Devoted Health Medicare |
$802.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.92
|
| Rate for Payer: Health Management Network Commercial |
$1,110.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$875.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$875.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$875.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$767.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$767.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.72
|
|
|
PR OSTEOTOMY RADIUS DISTAL THIRD
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 25350
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: AlohaCare Medicaid |
$707.61
|
| Rate for Payer: AlohaCare Medicare |
$640.23
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Devoted Health Medicare |
$704.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$640.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$544.96
|
| Rate for Payer: Health Management Network Commercial |
$1,034.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$768.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$768.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$768.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$707.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$640.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$707.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$640.23
|
|
|
PROSTHESIS PENILE 13MM MALLBLE
|
Facility
|
OP
|
$24,631.00
|
|
|
Service Code
|
HCPCS C2622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,561.81 |
| Max. Negotiated Rate |
$23,892.07 |
| Rate for Payer: Cash Price |
$14,778.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17,241.70
|
| Rate for Payer: Health Management Network Commercial |
$20,936.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$15,517.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12,561.81
|
| Rate for Payer: MDX Hawaii PPO |
$23,892.07
|
| Rate for Payer: University Health Alliance Commercial |
$13,793.36
|
|
|
PROSTHESIS PENILE 13MM MALLBLE
|
Facility
|
IP
|
$24,631.00
|
|
|
Service Code
|
HCPCS C2622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,793.36 |
| Max. Negotiated Rate |
$23,892.07 |
| Rate for Payer: Cash Price |
$14,778.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17,241.70
|
| Rate for Payer: Health Management Network Commercial |
$20,936.35
|
| Rate for Payer: MDX Hawaii PPO |
$23,892.07
|
| Rate for Payer: University Health Alliance Commercial |
$13,793.36
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
