|
PR ARTHRP INTERCARPAL/CARP/MTCRPL JT INTERPOSITION
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 25447
|
| Min. Negotiated Rate |
$613.86 |
| Max. Negotiated Rate |
$1,228.25 |
| Rate for Payer: AlohaCare Medicaid |
$871.87
|
| Rate for Payer: AlohaCare Medicare |
$762.36
|
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Devoted Health Medicare |
$838.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$762.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$613.86
|
| Rate for Payer: Health Management Network Commercial |
$1,228.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$914.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$914.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$914.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$871.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$762.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$871.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$762.36
|
|
|
PR ARTHRP INTERCARPAL/CARP/MTCRPL JT SUSPENSION
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 25448
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1,246.10 |
| Rate for Payer: AlohaCare Medicaid |
$0.90
|
| Rate for Payer: AlohaCare Medicare |
$837.72
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Devoted Health Medicare |
$921.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$837.72
|
| Rate for Payer: Health Management Network Commercial |
$1,246.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,005.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,005.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,005.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$837.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$837.72
|
|
|
PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$2,231.00
|
|
|
Service Code
|
HCPCS 27447
|
| Min. Negotiated Rate |
$1,155.81 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.50
|
| Rate for Payer: AlohaCare Medicare |
$1,155.81
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Devoted Health Medicare |
$1,271.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,155.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,777.62
|
| Rate for Payer: Health Management Network Commercial |
$1,896.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,386.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,386.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,386.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,155.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,155.81
|
|
|
PR ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 27446
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$1,706.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,169.31
|
| Rate for Payer: AlohaCare Medicare |
$1,048.74
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Devoted Health Medicare |
$1,153.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,048.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network Commercial |
$1,706.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,258.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,258.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,258.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,169.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,048.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,169.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,048.74
|
|
|
PR ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 26531
|
| Min. Negotiated Rate |
$514.02 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: AlohaCare Medicaid |
$667.90
|
| Rate for Payer: AlohaCare Medicare |
$604.71
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Devoted Health Medicare |
$665.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$604.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.02
|
| Rate for Payer: Health Management Network Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$725.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$725.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$667.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$604.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$667.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$604.71
|
|
|
PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 29888
|
| Min. Negotiated Rate |
$896.47 |
| Max. Negotiated Rate |
$1,456.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,000.09
|
| Rate for Payer: AlohaCare Medicare |
$896.47
|
| Rate for Payer: Cash Price |
$1,028.40
|
| Rate for Payer: Cash Price |
$1,028.40
|
| Rate for Payer: Devoted Health Medicare |
$986.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$896.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,159.34
|
| Rate for Payer: Health Management Network Commercial |
$1,456.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,075.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,075.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,075.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$896.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,000.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$896.47
|
|
|
PR ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 29855
|
| Min. Negotiated Rate |
$669.76 |
| Max. Negotiated Rate |
$1,183.20 |
| Rate for Payer: AlohaCare Medicaid |
$809.48
|
| Rate for Payer: AlohaCare Medicare |
$741.53
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Devoted Health Medicare |
$815.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$741.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$669.76
|
| Rate for Payer: Health Management Network Commercial |
$1,183.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$889.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$889.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$889.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$809.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$741.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$809.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$741.53
|
|
|
PR ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 29856
|
| Min. Negotiated Rate |
$773.76 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,019.63
|
| Rate for Payer: AlohaCare Medicare |
$924.55
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Devoted Health Medicare |
$1,017.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$924.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$773.76
|
| Rate for Payer: Health Management Network Commercial |
$1,489.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,109.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,109.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,019.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$924.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,019.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$924.55
|
|
|
PR ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 29879
|
| Min. Negotiated Rate |
$634.60 |
| Max. Negotiated Rate |
$1,007.25 |
| Rate for Payer: AlohaCare Medicaid |
$689.52
|
| Rate for Payer: AlohaCare Medicare |
$634.60
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Devoted Health Medicare |
$698.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$634.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$688.48
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$761.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$761.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$761.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$634.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$634.60
|
|
|
PR ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 29877
|
| Min. Negotiated Rate |
$599.29 |
| Max. Negotiated Rate |
$947.75 |
| Rate for Payer: AlohaCare Medicaid |
$648.83
|
| Rate for Payer: AlohaCare Medicare |
$599.29
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Devoted Health Medicare |
$659.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$599.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$628.16
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$719.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$719.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$719.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$648.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$599.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$648.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$599.29
|
|
|
PR ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 29886
|
| Min. Negotiated Rate |
$579.80 |
| Max. Negotiated Rate |
$973.25 |
| Rate for Payer: AlohaCare Medicaid |
$665.83
|
| Rate for Payer: AlohaCare Medicare |
$617.07
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Devoted Health Medicare |
$678.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$579.80
|
| Rate for Payer: Health Management Network Commercial |
$973.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$740.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$740.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$665.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$665.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.07
|
|
|
PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 29880
|
| Min. Negotiated Rate |
$545.72 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: AlohaCare Medicaid |
$589.17
|
| Rate for Payer: AlohaCare Medicare |
$545.72
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Devoted Health Medicare |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$545.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$724.62
|
| Rate for Payer: Health Management Network Commercial |
$859.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$654.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$654.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$654.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$589.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$545.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$589.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$545.72
|
|
|
PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 29881
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$830.45 |
| Rate for Payer: AlohaCare Medicaid |
$568.81
|
| Rate for Payer: AlohaCare Medicare |
$528.92
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Devoted Health Medicare |
$581.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$528.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.84
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$634.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$528.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$568.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$528.92
|
|
|
PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 27620
|
| Min. Negotiated Rate |
$372.58 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: AlohaCare Medicaid |
$472.79
|
| Rate for Payer: AlohaCare Medicare |
$448.57
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Devoted Health Medicare |
$493.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$372.58
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$538.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$538.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$538.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$472.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$472.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.57
|
|
|
PR ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 24000
|
| Min. Negotiated Rate |
$378.04 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: AlohaCare Medicaid |
$507.05
|
| Rate for Payer: AlohaCare Medicare |
$474.59
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Devoted Health Medicare |
$522.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$474.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.04
|
| Rate for Payer: Health Management Network Commercial |
$741.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$569.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$569.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$569.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$474.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$507.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$474.59
|
|
|
PR ARTHRT ELBOW W/JT EXPL W/WOBX W/O RMVL LOOSE/FB
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 24101
|
| Min. Negotiated Rate |
$395.98 |
| Max. Negotiated Rate |
$781.15 |
| Rate for Payer: AlohaCare Medicaid |
$534.45
|
| Rate for Payer: AlohaCare Medicare |
$497.37
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Devoted Health Medicare |
$547.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$497.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.98
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$596.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$596.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$596.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$534.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$497.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$534.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$497.37
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 26070
|
| Min. Negotiated Rate |
$238.68 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: AlohaCare Medicaid |
$348.35
|
| Rate for Payer: AlohaCare Medicare |
$326.19
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Devoted Health Medicare |
$358.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.68
|
| Rate for Payer: Health Management Network Commercial |
$508.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$391.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$348.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$348.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.19
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 26080
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: AlohaCare Medicaid |
$431.25
|
| Rate for Payer: AlohaCare Medicare |
$405.30
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Devoted Health Medicare |
$445.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$262.86
|
| Rate for Payer: Health Management Network Commercial |
$630.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$486.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$431.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$431.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.30
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 26075
|
| Min. Negotiated Rate |
$277.42 |
| Max. Negotiated Rate |
$533.80 |
| Rate for Payer: AlohaCare Medicaid |
$365.04
|
| Rate for Payer: AlohaCare Medicare |
$344.17
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$378.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$344.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.42
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$413.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$413.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$344.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$365.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$344.17
|
|
|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 27310
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: AlohaCare Medicaid |
$763.01
|
| Rate for Payer: AlohaCare Medicare |
$700.64
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Devoted Health Medicare |
$770.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$700.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$575.90
|
| Rate for Payer: Health Management Network Commercial |
$1,114.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$840.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$840.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$840.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$700.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$763.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$700.64
|
|
|
PR ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27331
|
| Min. Negotiated Rate |
$390.26 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: AlohaCare Medicaid |
$504.86
|
| Rate for Payer: AlohaCare Medicare |
$472.78
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Devoted Health Medicare |
$520.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.26
|
| Rate for Payer: Health Management Network Commercial |
$739.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$567.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$567.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$504.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$504.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.78
|
|
|
PR ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 25040
|
| Min. Negotiated Rate |
$404.56 |
| Max. Negotiated Rate |
$858.50 |
| Rate for Payer: AlohaCare Medicaid |
$586.72
|
| Rate for Payer: AlohaCare Medicare |
$536.14
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Devoted Health Medicare |
$589.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$536.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$404.56
|
| Rate for Payer: Health Management Network Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$643.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$643.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$643.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$586.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$536.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$586.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$536.14
|
|
|
PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT
|
Professional
|
Both
|
$1,166.00
|
|
|
Service Code
|
HCPCS 27332
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$991.10 |
| Rate for Payer: AlohaCare Medicaid |
$678.03
|
| Rate for Payer: AlohaCare Medicare |
$628.79
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Devoted Health Medicare |
$691.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$628.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.00
|
| Rate for Payer: Health Management Network Commercial |
$991.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$754.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$754.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$678.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.79
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$935.41
|
|
|
Service Code
|
HCPCS 28022
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$795.10 |
| Rate for Payer: AlohaCare Medicaid |
$345.37
|
| Rate for Payer: AlohaCare Medicare |
$325.27
|
| Rate for Payer: Cash Price |
$561.25
|
| Rate for Payer: Cash Price |
$561.25
|
| Rate for Payer: Devoted Health Medicare |
$357.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$345.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$523.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$325.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$345.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$235.04
|
| Rate for Payer: Health Management Network Commercial |
$795.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$325.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$345.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$325.27
|
| Rate for Payer: University Health Alliance Commercial |
$443.33
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT
|
Professional
|
Both
|
$1,059.47
|
|
|
Service Code
|
HCPCS 28020
|
| Min. Negotiated Rate |
$303.16 |
| Max. Negotiated Rate |
$900.55 |
| Rate for Payer: AlohaCare Medicaid |
$385.12
|
| Rate for Payer: AlohaCare Medicare |
$363.12
|
| Rate for Payer: Cash Price |
$635.68
|
| Rate for Payer: Cash Price |
$635.68
|
| Rate for Payer: Devoted Health Medicare |
$399.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$385.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$595.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$363.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$385.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$303.16
|
| Rate for Payer: Health Management Network Commercial |
$900.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$435.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$435.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$435.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$363.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$385.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$363.12
|
| Rate for Payer: University Health Alliance Commercial |
$503.95
|
|
