|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$295.82
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: AlohaCare Medicaid |
$83.87
|
| Rate for Payer: AlohaCare Medicare |
$74.85
|
| Rate for Payer: Cash Price |
$177.49
|
| Rate for Payer: Cash Price |
$177.49
|
| Rate for Payer: Devoted Health Medicare |
$82.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$130.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$251.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.85
|
| Rate for Payer: University Health Alliance Commercial |
$91.51
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$46.99
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: AlohaCare Medicaid |
$16.51
|
| Rate for Payer: AlohaCare Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$28.19
|
| Rate for Payer: Cash Price |
$28.19
|
| Rate for Payer: Devoted Health Medicare |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.12
|
| Rate for Payer: Health Management Network Commercial |
$39.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.31
|
| Rate for Payer: University Health Alliance Commercial |
$18.02
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$1,380.40 |
| Rate for Payer: AlohaCare Medicaid |
$945.34
|
| Rate for Payer: AlohaCare Medicare |
$856.16
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Devoted Health Medicare |
$941.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$856.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$730.34
|
| Rate for Payer: Health Management Network Commercial |
$1,380.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,027.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,027.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,027.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$945.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$856.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$945.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$856.16
|
|
|
PR ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 27485
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: AlohaCare Medicaid |
$700.66
|
| Rate for Payer: AlohaCare Medicare |
$643.90
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Devoted Health Medicare |
$708.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$643.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$1,023.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$772.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$772.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$772.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$700.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$643.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$700.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$643.90
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$575.14 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: AlohaCare Medicaid |
$625.24
|
| Rate for Payer: AlohaCare Medicare |
$575.14
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Devoted Health Medicare |
$632.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$575.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$623.48
|
| Rate for Payer: Health Management Network Commercial |
$906.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$690.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$690.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$690.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$625.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$575.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$625.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$575.14
|
| Rate for Payer: University Health Alliance Commercial |
$920.00
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$105.75
|
|
|
Service Code
|
HCPCS 20605
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: AlohaCare Medicaid |
$36.94
|
| Rate for Payer: AlohaCare Medicare |
$31.95
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Devoted Health Medicare |
$35.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$89.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.95
|
| Rate for Payer: University Health Alliance Commercial |
$48.93
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Professional
|
Both
|
$175.65
|
|
|
Service Code
|
HCPCS 20606
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$149.30 |
| Rate for Payer: AlohaCare Medicaid |
$51.78
|
| Rate for Payer: AlohaCare Medicare |
$44.17
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Devoted Health Medicare |
$48.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.32
|
| Rate for Payer: Health Management Network Commercial |
$149.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.17
|
| Rate for Payer: University Health Alliance Commercial |
$68.25
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$126.51
|
|
|
Service Code
|
HCPCS 20610
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$107.53 |
| Rate for Payer: AlohaCare Medicaid |
$45.55
|
| Rate for Payer: AlohaCare Medicare |
$39.25
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Cash Price |
$75.91
|
| Rate for Payer: Devoted Health Medicare |
$43.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.76
|
| Rate for Payer: Health Management Network Commercial |
$107.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.25
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$194.22
|
|
|
Service Code
|
HCPCS 20611
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$165.09 |
| Rate for Payer: AlohaCare Medicaid |
$58.92
|
| Rate for Payer: AlohaCare Medicare |
$49.46
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Devoted Health Medicare |
$54.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.32
|
| Rate for Payer: Health Management Network Commercial |
$165.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.46
|
| Rate for Payer: University Health Alliance Commercial |
$138.00
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$103.92
|
|
|
Service Code
|
HCPCS 20600
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$88.33 |
| Rate for Payer: AlohaCare Medicaid |
$35.89
|
| Rate for Payer: AlohaCare Medicare |
$31.28
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Devoted Health Medicare |
$34.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$88.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.28
|
| Rate for Payer: University Health Alliance Commercial |
$47.04
|
|
|
PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$162.91
|
|
|
Service Code
|
HCPCS 20604
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$138.47 |
| Rate for Payer: AlohaCare Medicaid |
$45.64
|
| Rate for Payer: AlohaCare Medicare |
$39.16
|
| Rate for Payer: Cash Price |
$97.75
|
| Rate for Payer: Cash Price |
$97.75
|
| Rate for Payer: Devoted Health Medicare |
$43.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$71.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network Commercial |
$138.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.16
|
| Rate for Payer: University Health Alliance Commercial |
$60.55
|
|
|
PR ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 27870
|
| Min. Negotiated Rate |
$823.68 |
| Max. Negotiated Rate |
$1,507.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,034.98
|
| Rate for Payer: AlohaCare Medicare |
$936.13
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Devoted Health Medicare |
$1,029.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$936.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$823.68
|
| Rate for Payer: Health Management Network Commercial |
$1,507.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,123.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,123.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,123.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,034.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$936.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,034.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$936.13
|
|
|
PR ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$1,772.00
|
|
|
Service Code
|
HCPCS 24802
|
| Min. Negotiated Rate |
$765.18 |
| Max. Negotiated Rate |
$1,506.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,031.47
|
| Rate for Payer: AlohaCare Medicare |
$934.06
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Devoted Health Medicare |
$1,027.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$934.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$765.18
|
| Rate for Payer: Health Management Network Commercial |
$1,506.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,120.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,120.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,120.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,031.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$934.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,031.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$934.06
|
|
|
PR ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$1,139.78
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$319.28 |
| Max. Negotiated Rate |
$968.81 |
| Rate for Payer: AlohaCare Medicaid |
$671.67
|
| Rate for Payer: AlohaCare Medicare |
$650.92
|
| Rate for Payer: Cash Price |
$683.87
|
| Rate for Payer: Cash Price |
$683.87
|
| Rate for Payer: Devoted Health Medicare |
$716.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$650.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.28
|
| Rate for Payer: Health Management Network Commercial |
$968.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$781.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$781.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$671.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$650.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$671.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$650.92
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$84.62 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: AlohaCare Medicaid |
$100.80
|
| Rate for Payer: AlohaCare Medicare |
$84.62
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Devoted Health Medicare |
$93.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.72
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.62
|
|
|
PR ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$397.02 |
| Max. Negotiated Rate |
$1,143.25 |
| Rate for Payer: AlohaCare Medicaid |
$792.80
|
| Rate for Payer: AlohaCare Medicare |
$746.76
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Devoted Health Medicare |
$821.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$746.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$397.02
|
| Rate for Payer: Health Management Network Commercial |
$1,143.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$896.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$896.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$896.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$792.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$746.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$792.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$746.76
|
|
|
PR ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$633.10 |
| Max. Negotiated Rate |
$1,180.65 |
| Rate for Payer: AlohaCare Medicaid |
$809.44
|
| Rate for Payer: AlohaCare Medicare |
$744.49
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Devoted Health Medicare |
$818.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$744.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$633.10
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$893.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$893.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$809.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$744.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$809.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$744.49
|
|
|
PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$626.60 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: AlohaCare Medicaid |
$763.10
|
| Rate for Payer: AlohaCare Medicare |
$685.64
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Devoted Health Medicare |
$754.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$685.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.60
|
| Rate for Payer: Health Management Network Commercial |
$1,116.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$822.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$822.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$822.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$685.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$763.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$685.64
|
|
|
PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$1,183.00
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: AlohaCare Medicaid |
$690.05
|
| Rate for Payer: AlohaCare Medicare |
$638.42
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Devoted Health Medicare |
$702.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.18
|
| Rate for Payer: Health Management Network Commercial |
$1,005.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$690.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$690.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.42
|
|
|
PR ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$769.14 |
| Max. Negotiated Rate |
$1,223.15 |
| Rate for Payer: AlohaCare Medicaid |
$839.61
|
| Rate for Payer: AlohaCare Medicare |
$769.14
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Devoted Health Medicare |
$846.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$769.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.56
|
| Rate for Payer: Health Management Network Commercial |
$1,223.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$922.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$922.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$922.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$839.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$769.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$839.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$769.14
|
|
|
PR ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 27442
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$1,313.25 |
| Rate for Payer: AlohaCare Medicaid |
$896.38
|
| Rate for Payer: AlohaCare Medicare |
$812.90
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Devoted Health Medicare |
$894.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$812.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$768.04
|
| Rate for Payer: Health Management Network Commercial |
$1,313.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$975.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$975.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$975.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$896.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$812.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$896.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$812.90
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$2,514.00
|
|
|
Service Code
|
HCPCS 23472
|
| Min. Negotiated Rate |
$1,093.82 |
| Max. Negotiated Rate |
$2,136.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,465.59
|
| Rate for Payer: AlohaCare Medicare |
$1,298.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Devoted Health Medicare |
$1,428.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,298.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,093.82
|
| Rate for Payer: Health Management Network Commercial |
$2,136.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,558.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,558.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,558.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,465.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,298.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,465.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,298.43
|
|
|
PR ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY
|
Professional
|
Both
|
$2,097.00
|
|
|
Service Code
|
HCPCS 23470
|
| Min. Negotiated Rate |
$1,011.66 |
| Max. Negotiated Rate |
$1,782.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,222.51
|
| Rate for Payer: AlohaCare Medicare |
$1,090.75
|
| Rate for Payer: Cash Price |
$1,258.20
|
| Rate for Payer: Cash Price |
$1,258.20
|
| Rate for Payer: Devoted Health Medicare |
$1,199.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,090.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,011.66
|
| Rate for Payer: Health Management Network Commercial |
$1,782.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,308.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,308.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,308.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,222.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,090.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,222.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,090.75
|
|
|
PR ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 26536
|
| Min. Negotiated Rate |
$466.96 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: AlohaCare Medicaid |
$815.05
|
| Rate for Payer: AlohaCare Medicare |
$779.29
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Devoted Health Medicare |
$857.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$466.96
|
| Rate for Payer: Health Management Network Commercial |
$1,173.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$935.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$935.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$815.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$815.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.29
|
|
|
PR ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 25445
|
| Min. Negotiated Rate |
$625.30 |
| Max. Negotiated Rate |
$1,100.75 |
| Rate for Payer: AlohaCare Medicaid |
$752.77
|
| Rate for Payer: AlohaCare Medicare |
$676.25
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Devoted Health Medicare |
$743.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$676.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$625.30
|
| Rate for Payer: Health Management Network Commercial |
$1,100.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$811.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$811.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$811.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$752.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$676.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$752.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$676.25
|
|
