|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION [6462]
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
NDC 60977014101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$796.45 |
| Max. Negotiated Rate |
$908.89 |
| Rate for Payer: Cash Price |
$562.20
|
| Rate for Payer: Health Management Network Commercial |
$796.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$843.30
|
| Rate for Payer: MDX Hawaii PPO |
$908.89
|
|
|
PR AMBULATORY SURGICAL BOOT EAC
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS L3260
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: AlohaCare Medicaid |
$2.28
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.00
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.28
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [21287]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 13668009190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.41
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.41
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [21287]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 13668009190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [22719]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 13668009390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [22719]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 13668009390
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.41
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.41
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
PRAMOXINE-CALAMINE 1 %-8 % LOTION [13384]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 24385007282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicare |
$7.13
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Devoted Health Medicare |
$7.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Humana Medicare |
$7.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.13
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.13
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
PRAMOXINE-CALAMINE 1 %-8 % LOTION [13384]
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 24385007282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$359.32 |
| Max. Negotiated Rate |
$1,067.60 |
| Rate for Payer: AlohaCare Medicaid |
$739.33
|
| Rate for Payer: AlohaCare Medicare |
$707.31
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Devoted Health Medicare |
$778.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$707.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$359.32
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$848.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$848.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$848.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$739.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$707.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$739.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$707.31
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,306.34
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$357.50 |
| Max. Negotiated Rate |
$1,110.39 |
| Rate for Payer: AlohaCare Medicaid |
$765.05
|
| Rate for Payer: AlohaCare Medicare |
$746.48
|
| Rate for Payer: Cash Price |
$783.80
|
| Rate for Payer: Cash Price |
$783.80
|
| Rate for Payer: Devoted Health Medicare |
$821.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$746.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network Commercial |
$1,110.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$895.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$895.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$895.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$746.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$746.48
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$506.22 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: AlohaCare Medicaid |
$649.37
|
| Rate for Payer: AlohaCare Medicare |
$595.65
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Devoted Health Medicare |
$655.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$595.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$506.22
|
| Rate for Payer: Health Management Network Commercial |
$943.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$714.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$714.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$714.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$649.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$595.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$649.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$595.65
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$846.60 |
| Rate for Payer: AlohaCare Medicaid |
$581.74
|
| Rate for Payer: AlohaCare Medicare |
$545.53
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Devoted Health Medicare |
$600.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$545.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$364.00
|
| Rate for Payer: Health Management Network Commercial |
$846.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$654.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$654.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$654.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$581.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$545.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$581.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$545.53
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$423.54 |
| Max. Negotiated Rate |
$1,181.50 |
| Rate for Payer: AlohaCare Medicaid |
$817.04
|
| Rate for Payer: AlohaCare Medicare |
$779.40
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Devoted Health Medicare |
$857.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$779.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.54
|
| Rate for Payer: Health Management Network Commercial |
$1,181.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$935.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$935.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$817.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$779.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$817.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$779.40
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$1,369.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,163.65 |
| Rate for Payer: AlohaCare Medicaid |
$767.04
|
| Rate for Payer: AlohaCare Medicare |
$734.02
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Devoted Health Medicare |
$807.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$734.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$1,163.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$880.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$880.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$880.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$767.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$767.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.02
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$446.94 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: AlohaCare Medicaid |
$715.54
|
| Rate for Payer: AlohaCare Medicare |
$652.50
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Devoted Health Medicare |
$717.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$446.94
|
| Rate for Payer: Health Management Network Commercial |
$1,042.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$783.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$783.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$783.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$715.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$715.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.50
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$1,274.15 |
| Rate for Payer: AlohaCare Medicaid |
$878.69
|
| Rate for Payer: AlohaCare Medicare |
$798.38
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Devoted Health Medicare |
$878.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$798.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$611.00
|
| Rate for Payer: Health Management Network Commercial |
$1,274.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$958.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$958.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$958.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$878.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$798.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$878.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$798.38
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$507.78 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: AlohaCare Medicaid |
$581.65
|
| Rate for Payer: AlohaCare Medicare |
$540.08
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Devoted Health Medicare |
$594.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$540.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$507.78
|
| Rate for Payer: Health Management Network Commercial |
$844.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$648.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$648.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$581.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$540.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$581.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$540.08
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$403.67 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: AlohaCare Medicaid |
$434.96
|
| Rate for Payer: AlohaCare Medicare |
$403.67
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Devoted Health Medicare |
$444.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$403.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$413.40
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$484.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$484.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.67
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: AlohaCare Medicaid |
$644.14
|
| Rate for Payer: AlohaCare Medicare |
$580.47
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Devoted Health Medicare |
$638.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.90
|
| Rate for Payer: Health Management Network Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$696.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$696.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$696.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$644.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.47
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$640.12 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: AlohaCare Medicaid |
$765.70
|
| Rate for Payer: AlohaCare Medicare |
$698.89
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Devoted Health Medicare |
$768.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$698.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$640.12
|
| Rate for Payer: Health Management Network Commercial |
$1,107.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$838.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$838.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$838.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$765.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$698.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$765.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$698.89
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$551.98 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: AlohaCare Medicaid |
$707.95
|
| Rate for Payer: AlohaCare Medicare |
$650.84
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Devoted Health Medicare |
$715.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$650.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.98
|
| Rate for Payer: Health Management Network Commercial |
$1,028.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$781.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$781.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$781.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$707.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$650.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$707.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$650.84
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$556.66 |
| Max. Negotiated Rate |
$970.70 |
| Rate for Payer: AlohaCare Medicaid |
$661.88
|
| Rate for Payer: AlohaCare Medicare |
$616.69
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Devoted Health Medicare |
$678.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$616.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.66
|
| Rate for Payer: Health Management Network Commercial |
$970.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$740.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$740.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$661.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$616.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$661.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$616.69
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$537.57
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$456.93 |
| Rate for Payer: AlohaCare Medicaid |
$173.00
|
| Rate for Payer: AlohaCare Medicare |
$155.27
|
| Rate for Payer: Cash Price |
$322.54
|
| Rate for Payer: Cash Price |
$322.54
|
| Rate for Payer: Devoted Health Medicare |
$170.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$173.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$173.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.36
|
| Rate for Payer: Health Management Network Commercial |
$456.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.27
|
| Rate for Payer: University Health Alliance Commercial |
$228.04
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$550.41
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$499.04 |
| Rate for Payer: AlohaCare Medicaid |
$177.28
|
| Rate for Payer: AlohaCare Medicare |
$160.33
|
| Rate for Payer: Cash Price |
$330.25
|
| Rate for Payer: Cash Price |
$330.25
|
| Rate for Payer: Devoted Health Medicare |
$176.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$177.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$499.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$177.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.80
|
| Rate for Payer: Health Management Network Commercial |
$467.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$177.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.33
|
| Rate for Payer: University Health Alliance Commercial |
$234.58
|
|
|
PR ANKLE DISARTICULATION
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 27889
|
| Min. Negotiated Rate |
$554.58 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: AlohaCare Medicaid |
$634.31
|
| Rate for Payer: AlohaCare Medicare |
$588.08
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Devoted Health Medicare |
$646.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$588.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$554.58
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$705.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$705.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$634.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$588.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$634.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$588.08
|
|
