|
PR ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 29851
|
| Min. Negotiated Rate |
$720.46 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: AlohaCare Medicaid |
$957.08
|
| Rate for Payer: AlohaCare Medicare |
$869.38
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Devoted Health Medicare |
$956.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$869.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$720.46
|
| Rate for Payer: Health Management Network Commercial |
$1,398.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,043.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,043.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,043.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$957.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$869.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$957.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$869.38
|
|
|
PR ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 29850
|
| Min. Negotiated Rate |
$515.06 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: AlohaCare Medicaid |
$653.36
|
| Rate for Payer: AlohaCare Medicare |
$606.10
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Devoted Health Medicare |
$666.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$606.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$515.06
|
| Rate for Payer: Health Management Network Commercial |
$955.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$727.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$727.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$727.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$653.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$606.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$653.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$606.10
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 29897
|
| Min. Negotiated Rate |
$474.35 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: AlohaCare Medicaid |
$515.27
|
| Rate for Payer: AlohaCare Medicare |
$474.35
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Devoted Health Medicare |
$521.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$474.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$617.76
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$569.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$569.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$569.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$515.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$474.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$515.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$474.35
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
HCPCS 29895
|
| Min. Negotiated Rate |
$442.69 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: AlohaCare Medicaid |
$481.28
|
| Rate for Payer: AlohaCare Medicare |
$442.69
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Devoted Health Medicare |
$486.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$593.58
|
| Rate for Payer: Health Management Network Commercial |
$697.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$481.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$481.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.69
|
|
|
PR ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 29860
|
| Min. Negotiated Rate |
$627.86 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: AlohaCare Medicaid |
$683.00
|
| Rate for Payer: AlohaCare Medicare |
$627.86
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Devoted Health Medicare |
$690.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$627.86
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$753.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$753.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$753.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$683.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$683.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.86
|
|
|
PR ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX
|
Professional
|
Both
|
$1,125.48
|
|
|
Service Code
|
HCPCS 29870
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$956.66 |
| Rate for Payer: AlohaCare Medicaid |
$433.72
|
| Rate for Payer: AlohaCare Medicare |
$412.23
|
| Rate for Payer: Cash Price |
$675.29
|
| Rate for Payer: Cash Price |
$675.29
|
| Rate for Payer: Devoted Health Medicare |
$453.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$433.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$659.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$433.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$371.28
|
| Rate for Payer: Health Management Network Commercial |
$956.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$494.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$494.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$433.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$433.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.23
|
| Rate for Payer: University Health Alliance Commercial |
$546.13
|
|
|
PR ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS 29871
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: AlohaCare Medicaid |
$541.64
|
| Rate for Payer: AlohaCare Medicare |
$503.64
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Devoted Health Medicare |
$554.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$503.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.64
|
| Rate for Payer: Health Management Network Commercial |
$791.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$604.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$604.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$604.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$541.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$503.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$541.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$503.64
|
|
|
PR ARTHROSCOPY KNEE LATERAL RELEASE
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 29873
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: AlohaCare Medicaid |
$573.17
|
| Rate for Payer: AlohaCare Medicare |
$541.13
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Devoted Health Medicare |
$595.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$541.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$448.50
|
| Rate for Payer: Health Management Network Commercial |
$835.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$649.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$649.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$649.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$573.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$541.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$573.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$541.13
|
|
|
PR ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 29866
|
| Min. Negotiated Rate |
$931.58 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,087.07
|
| Rate for Payer: AlohaCare Medicare |
$991.39
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Devoted Health Medicare |
$1,090.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$991.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$931.58
|
| Rate for Payer: Health Management Network Commercial |
$1,587.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,189.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,189.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,189.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,087.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$991.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,087.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$991.39
|
|
|
PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 29874
|
| Min. Negotiated Rate |
$516.81 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: AlohaCare Medicaid |
$563.21
|
| Rate for Payer: AlohaCare Medicare |
$516.81
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Devoted Health Medicare |
$568.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$516.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.70
|
| Rate for Payer: Health Management Network Commercial |
$818.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$620.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$620.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$563.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$516.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$563.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$516.81
|
|
|
PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 29876
|
| Min. Negotiated Rate |
$626.58 |
| Max. Negotiated Rate |
$993.65 |
| Rate for Payer: AlohaCare Medicaid |
$680.57
|
| Rate for Payer: AlohaCare Medicare |
$626.58
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Devoted Health Medicare |
$689.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$626.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$677.56
|
| Rate for Payer: Health Management Network Commercial |
$993.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$751.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$751.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$751.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$680.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$626.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$680.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$626.58
|
|
|
PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
HCPCS 29875
|
| Min. Negotiated Rate |
$486.07 |
| Max. Negotiated Rate |
$761.60 |
| Rate for Payer: AlohaCare Medicaid |
$522.01
|
| Rate for Payer: AlohaCare Medicare |
$486.07
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Devoted Health Medicare |
$534.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$486.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$544.44
|
| Rate for Payer: Health Management Network Commercial |
$761.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$583.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$583.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$522.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$522.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$486.07
|
|
|
PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX
|
Professional
|
Both
|
$1,113.00
|
|
|
Service Code
|
HCPCS 29884
|
| Min. Negotiated Rate |
$598.63 |
| Max. Negotiated Rate |
$946.05 |
| Rate for Payer: AlohaCare Medicaid |
$647.79
|
| Rate for Payer: AlohaCare Medicare |
$598.63
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Devoted Health Medicare |
$658.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$598.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$624.78
|
| Rate for Payer: Health Management Network Commercial |
$946.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$718.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$647.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$647.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$598.63
|
|
|
PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
HCPCS 29883
|
| Min. Negotiated Rate |
$618.02 |
| Max. Negotiated Rate |
$1,266.50 |
| Rate for Payer: AlohaCare Medicaid |
$872.05
|
| Rate for Payer: AlohaCare Medicare |
$796.15
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Devoted Health Medicare |
$875.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$796.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$618.02
|
| Rate for Payer: Health Management Network Commercial |
$1,266.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$955.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$955.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$955.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$872.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$796.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$872.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$796.15
|
|
|
PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 29882
|
| Min. Negotiated Rate |
$652.42 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: AlohaCare Medicaid |
$715.35
|
| Rate for Payer: AlohaCare Medicare |
$652.42
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Devoted Health Medicare |
$717.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$727.48
|
| Rate for Payer: Health Management Network Commercial |
$1,043.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$782.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$782.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$715.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$715.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.42
|
|
|
PR ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 29906
|
| Min. Negotiated Rate |
$638.99 |
| Max. Negotiated Rate |
$1,011.50 |
| Rate for Payer: AlohaCare Medicaid |
$679.69
|
| Rate for Payer: AlohaCare Medicare |
$638.99
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Devoted Health Medicare |
$702.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.99
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$679.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$679.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.99
|
|
|
PR ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 29844
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: AlohaCare Medicaid |
$525.95
|
| Rate for Payer: AlohaCare Medicare |
$483.12
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Devoted Health Medicare |
$531.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$379.86
|
| Rate for Payer: Health Management Network Commercial |
$772.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$579.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$579.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$579.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$525.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$525.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.12
|
|
|
PR ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 27610
|
| Min. Negotiated Rate |
$488.54 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: AlohaCare Medicaid |
$671.70
|
| Rate for Payer: AlohaCare Medicare |
$621.79
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Devoted Health Medicare |
$683.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$621.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$488.54
|
| Rate for Payer: Health Management Network Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$746.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$746.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$671.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$621.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$671.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$621.79
|
|
|
PR ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 26105
|
| Min. Negotiated Rate |
$288.08 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: AlohaCare Medicaid |
$369.25
|
| Rate for Payer: AlohaCare Medicare |
$355.01
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Devoted Health Medicare |
$390.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$355.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.08
|
| Rate for Payer: Health Management Network Commercial |
$539.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$426.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$426.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$426.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$369.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$355.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$369.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$355.01
|
|
|
PR ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 23100
|
| Min. Negotiated Rate |
$399.10 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: AlohaCare Medicaid |
$538.18
|
| Rate for Payer: AlohaCare Medicare |
$506.91
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Devoted Health Medicare |
$557.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.10
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$538.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$538.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.91
|
|
|
PR ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 23040
|
| Min. Negotiated Rate |
$572.26 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: AlohaCare Medicaid |
$747.65
|
| Rate for Payer: AlohaCare Medicare |
$685.19
|
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Cash Price |
$769.80
|
| Rate for Payer: Devoted Health Medicare |
$753.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$685.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$572.26
|
| Rate for Payer: Health Management Network Commercial |
$1,090.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$822.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$822.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$822.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$747.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$685.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$747.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$685.19
|
|
|
PR ARTHROTOMY HIP W/DRAINAGE
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
HCPCS 27030
|
| Min. Negotiated Rate |
$738.40 |
| Max. Negotiated Rate |
$1,400.80 |
| Rate for Payer: AlohaCare Medicaid |
$960.09
|
| Rate for Payer: AlohaCare Medicare |
$865.20
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Devoted Health Medicare |
$951.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$865.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$738.40
|
| Rate for Payer: Health Management Network Commercial |
$1,400.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,038.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,038.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,038.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$960.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$865.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$960.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$865.20
|
|
|
PR ARTHROTOMY W/MENISCUS REPAIR KNEE
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 27403
|
| Min. Negotiated Rate |
$519.48 |
| Max. Negotiated Rate |
$986.85 |
| Rate for Payer: AlohaCare Medicaid |
$675.51
|
| Rate for Payer: AlohaCare Medicare |
$622.98
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Devoted Health Medicare |
$685.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$519.48
|
| Rate for Payer: Health Management Network Commercial |
$986.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$747.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$747.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$747.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$675.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$675.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.98
|
|
|
PR ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Professional
|
Both
|
$1,021.00
|
|
|
Service Code
|
HCPCS 27625
|
| Min. Negotiated Rate |
$516.62 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: AlohaCare Medicaid |
$598.16
|
| Rate for Payer: AlohaCare Medicare |
$560.34
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Devoted Health Medicare |
$616.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$560.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.62
|
| Rate for Payer: Health Management Network Commercial |
$867.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$672.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$672.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$598.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$560.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$598.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$560.34
|
|
|
PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27130
|
| Min. Negotiated Rate |
$1,158.29 |
| Max. Negotiated Rate |
$1,898.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,301.40
|
| Rate for Payer: AlohaCare Medicare |
$1,158.29
|
| Rate for Payer: Cash Price |
$1,340.40
|
| Rate for Payer: Cash Price |
$1,340.40
|
| Rate for Payer: Devoted Health Medicare |
$1,274.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,158.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,672.32
|
| Rate for Payer: Health Management Network Commercial |
$1,898.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,389.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,389.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,389.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,301.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,158.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,301.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,158.29
|
|
