|
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 26418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 26410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
CPT 49507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$24,500.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO YOUNGER THAN 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 49500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$7,647.81
|
| Rate for Payer: AlohaCare Medicare |
$7,647.81
|
| Rate for Payer: Devoted Health Medicare |
$8,412.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,647.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$7,647.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,647.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,412.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,647.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,647.81
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 12045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$873.10
|
| Rate for Payer: AlohaCare Medicare |
$873.10
|
| Rate for Payer: Devoted Health Medicare |
$960.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,091.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$873.10
|
| Rate for Payer: Humana Medicare |
$873.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$873.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$960.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$873.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$873.10
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 12042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$5,160.40
|
|
|
Service Code
|
CPT 12035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.98 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 12031
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 12032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$5,160.40
|
|
|
Service Code
|
CPT 12034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$129.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
|
Facility
|
OP
|
$13,923.44
|
|
|
Service Code
|
CPT 24343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$13,923.44 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$13,923.44
|
|
|
REPAIR NASAL SEPTAL PERFORATIONS
|
Facility
|
OP
|
$16,700.00
|
|
|
Service Code
|
CPT 30630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,916.70
|
| Rate for Payer: AlohaCare Medicare |
$3,916.70
|
| Rate for Payer: Devoted Health Medicare |
$4,308.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,916.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$3,916.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,916.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,308.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,916.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,916.70
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 49594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$13,778.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$11,157.19
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 49593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$7,647.81
|
| Rate for Payer: AlohaCare Medicare |
$7,647.81
|
| Rate for Payer: Devoted Health Medicare |
$8,412.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,647.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$7,647.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,647.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,412.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,647.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,647.81
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$13,778.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$8,270.00
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,270.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 49615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$13,778.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,647.81
|
| Rate for Payer: AlohaCare Medicare |
$7,647.81
|
| Rate for Payer: Devoted Health Medicare |
$8,412.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,647.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Humana Medicare |
$7,647.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,647.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,412.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,647.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,647.81
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 49613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$13,778.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 26540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 67917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$2,808.63
|
| Rate for Payer: AlohaCare Medicare |
$2,808.63
|
| Rate for Payer: Devoted Health Medicare |
$3,089.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,808.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Humana Medicare |
$2,808.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,808.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,089.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,808.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,808.63
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF ENTEROCUTANEOUS FISTULA SMALL INTESTINE OR COLON (EXCLUDING ANORECTAL FISTULA) WITH PLUG (E.G., PORCINE SMALL INTESTINE SUBMUCOSA [SIS])
|
Facility
|
OP
|
$4,098.76
|
|
|
Service Code
|
CPT C9796
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,098.76 |
| Rate for Payer: AlohaCare Medicaid |
$3,279.01
|
| Rate for Payer: AlohaCare Medicare |
$3,279.01
|
| Rate for Payer: Devoted Health Medicare |
$3,606.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,098.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,279.01
|
| Rate for Payer: Humana Medicare |
$3,279.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,279.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,606.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,279.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,279.01
|
|
|
REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
|
|
REPAIR OF NAIL BED
|
Facility
|
OP
|
$4,035.20
|
|
|
Service Code
|
CPT 11760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$873.10
|
| Rate for Payer: AlohaCare Medicare |
$873.10
|
| Rate for Payer: Devoted Health Medicare |
$960.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$873.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Humana Medicare |
$873.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$873.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$960.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$873.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$873.10
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
