|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: AlohaCare Medicaid |
$740.21
|
| Rate for Payer: AlohaCare Medicare |
$659.83
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Devoted Health Medicare |
$725.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$659.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$698.10
|
| Rate for Payer: Health Management Network Commercial |
$1,075.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$791.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$791.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$740.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$659.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$740.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$659.83
|
| Rate for Payer: University Health Alliance Commercial |
$1,026.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$598.41 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: AlohaCare Medicaid |
$673.84
|
| Rate for Payer: AlohaCare Medicare |
$598.41
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Devoted Health Medicare |
$658.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$598.41
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$718.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$673.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$598.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$673.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$598.41
|
| Rate for Payer: University Health Alliance Commercial |
$800.00
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$876.54
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$250.99 |
| Max. Negotiated Rate |
$745.06 |
| Rate for Payer: AlohaCare Medicaid |
$280.66
|
| Rate for Payer: AlohaCare Medicare |
$250.99
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Cash Price |
$525.92
|
| Rate for Payer: Devoted Health Medicare |
$276.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$280.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$280.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$308.36
|
| Rate for Payer: Health Management Network Commercial |
$745.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.99
|
| Rate for Payer: University Health Alliance Commercial |
$321.89
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,000.07
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$850.06 |
| Rate for Payer: AlohaCare Medicaid |
$296.15
|
| Rate for Payer: AlohaCare Medicare |
$261.39
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Cash Price |
$600.04
|
| Rate for Payer: Devoted Health Medicare |
$287.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$296.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$460.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$296.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.10
|
| Rate for Payer: Health Management Network Commercial |
$850.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$296.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.39
|
| Rate for Payer: University Health Alliance Commercial |
$500.00
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$922.90 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,029.44
|
| Rate for Payer: AlohaCare Medicare |
$922.90
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Devoted Health Medicare |
$1,015.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$922.90
|
| Rate for Payer: Health Management Network Commercial |
$1,501.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,107.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,107.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,107.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,029.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$922.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,029.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$922.90
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$437.32 |
| Max. Negotiated Rate |
$1,007.25 |
| Rate for Payer: AlohaCare Medicaid |
$689.07
|
| Rate for Payer: AlohaCare Medicare |
$638.56
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Devoted Health Medicare |
$702.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$638.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.32
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$766.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$766.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$689.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$638.56
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$1,128.93 |
| Max. Negotiated Rate |
$1,831.75 |
| Rate for Payer: AlohaCare Medicaid |
$1,255.28
|
| Rate for Payer: AlohaCare Medicare |
$1,128.93
|
| Rate for Payer: Cash Price |
$1,293.00
|
| Rate for Payer: Cash Price |
$1,293.00
|
| Rate for Payer: Devoted Health Medicare |
$1,241.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,128.93
|
| Rate for Payer: Health Management Network Commercial |
$1,831.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,354.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,354.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,354.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,255.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,128.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,255.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,128.93
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,356.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$1,152.60 |
| Rate for Payer: AlohaCare Medicaid |
$803.97
|
| Rate for Payer: AlohaCare Medicare |
$772.39
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Devoted Health Medicare |
$849.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$772.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$451.36
|
| Rate for Payer: Health Management Network Commercial |
$1,152.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$926.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$926.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$926.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$772.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$803.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$772.39
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: AlohaCare Medicaid |
$407.08
|
| Rate for Payer: AlohaCare Medicare |
$377.59
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Devoted Health Medicare |
$415.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$377.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.58
|
| Rate for Payer: Health Management Network Commercial |
$595.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$453.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$453.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$453.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$407.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$377.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$407.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$377.59
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$682.55 |
| Rate for Payer: AlohaCare Medicaid |
$470.98
|
| Rate for Payer: AlohaCare Medicare |
$434.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Devoted Health Medicare |
$478.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$457.34
|
| Rate for Payer: Health Management Network Commercial |
$682.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$521.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$521.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$470.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$470.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.80
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$1,421.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,207.85 |
| Rate for Payer: AlohaCare Medicaid |
$821.17
|
| Rate for Payer: AlohaCare Medicare |
$752.42
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Devoted Health Medicare |
$827.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$752.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.00
|
| Rate for Payer: Health Management Network Commercial |
$1,207.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$902.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$902.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$902.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$821.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$752.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$821.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$752.42
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: AlohaCare Medicaid |
$549.29
|
| Rate for Payer: AlohaCare Medicare |
$523.22
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Devoted Health Medicare |
$575.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$523.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$332.80
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$627.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$523.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$523.22
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$282.36 |
| Max. Negotiated Rate |
$663.85 |
| Rate for Payer: AlohaCare Medicaid |
$459.40
|
| Rate for Payer: AlohaCare Medicare |
$427.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Devoted Health Medicare |
$470.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$427.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$282.36
|
| Rate for Payer: Health Management Network Commercial |
$663.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$513.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$513.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$427.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$459.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$427.60
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$585.11
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$198.39 |
| Max. Negotiated Rate |
$497.34 |
| Rate for Payer: AlohaCare Medicaid |
$223.77
|
| Rate for Payer: AlohaCare Medicare |
$198.39
|
| Rate for Payer: Cash Price |
$351.07
|
| Rate for Payer: Cash Price |
$351.07
|
| Rate for Payer: Devoted Health Medicare |
$218.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$223.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$429.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$223.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.52
|
| Rate for Payer: Health Management Network Commercial |
$497.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.39
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$230.35
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: AlohaCare Medicaid |
$94.37
|
| Rate for Payer: AlohaCare Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Devoted Health Medicare |
$90.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.37
|
| Rate for Payer: Health Management Network Commercial |
$195.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.26
|
| Rate for Payer: University Health Alliance Commercial |
$109.82
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$413.18
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$351.20 |
| Rate for Payer: AlohaCare Medicaid |
$147.04
|
| Rate for Payer: AlohaCare Medicare |
$132.81
|
| Rate for Payer: Cash Price |
$247.91
|
| Rate for Payer: Cash Price |
$247.91
|
| Rate for Payer: Devoted Health Medicare |
$146.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$225.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$147.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$351.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.81
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$145.78
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$123.91 |
| Rate for Payer: AlohaCare Medicaid |
$52.44
|
| Rate for Payer: AlohaCare Medicare |
$44.57
|
| Rate for Payer: Cash Price |
$87.47
|
| Rate for Payer: Cash Price |
$87.47
|
| Rate for Payer: Devoted Health Medicare |
$49.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$123.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.57
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$442.42
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$376.06 |
| Rate for Payer: AlohaCare Medicaid |
$153.95
|
| Rate for Payer: AlohaCare Medicare |
$137.36
|
| Rate for Payer: Cash Price |
$265.45
|
| Rate for Payer: Cash Price |
$265.45
|
| Rate for Payer: Devoted Health Medicare |
$151.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$153.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$316.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$153.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.22
|
| Rate for Payer: Health Management Network Commercial |
$376.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.36
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$137.99
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$117.29 |
| Rate for Payer: AlohaCare Medicaid |
$53.52
|
| Rate for Payer: AlohaCare Medicare |
$46.19
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Devoted Health Medicare |
$50.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$79.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.52
|
| Rate for Payer: Health Management Network Commercial |
$117.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.19
|
| Rate for Payer: University Health Alliance Commercial |
$62.70
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$61.67
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: AlohaCare Medicaid |
$13.89
|
| Rate for Payer: AlohaCare Medicare |
$12.45
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Devoted Health Medicare |
$13.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.74
|
| Rate for Payer: Health Management Network Commercial |
$52.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.45
|
| Rate for Payer: University Health Alliance Commercial |
$15.40
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$83.84
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: AlohaCare Medicaid |
$23.31
|
| Rate for Payer: AlohaCare Medicare |
$20.95
|
| Rate for Payer: Cash Price |
$50.30
|
| Rate for Payer: Cash Price |
$50.30
|
| Rate for Payer: Devoted Health Medicare |
$23.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.12
|
| Rate for Payer: Health Management Network Commercial |
$71.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.95
|
| Rate for Payer: University Health Alliance Commercial |
$25.55
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$194.41
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$165.25 |
| Rate for Payer: AlohaCare Medicaid |
$35.17
|
| Rate for Payer: AlohaCare Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Cash Price |
$116.65
|
| Rate for Payer: Devoted Health Medicare |
$34.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.88
|
| Rate for Payer: Health Management Network Commercial |
$165.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.95
|
| Rate for Payer: University Health Alliance Commercial |
$145.00
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$89.16
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: AlohaCare Medicaid |
$24.27
|
| Rate for Payer: AlohaCare Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Devoted Health Medicare |
$23.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$72.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.18
|
| Rate for Payer: Health Management Network Commercial |
$75.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.32
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$252.42
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$214.56 |
| Rate for Payer: AlohaCare Medicaid |
$61.67
|
| Rate for Payer: AlohaCare Medicare |
$56.51
|
| Rate for Payer: Cash Price |
$151.45
|
| Rate for Payer: Cash Price |
$151.45
|
| Rate for Payer: Devoted Health Medicare |
$62.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.16
|
| Rate for Payer: Health Management Network Commercial |
$214.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.51
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$77.53
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$65.90 |
| Rate for Payer: AlohaCare Medicaid |
$24.64
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Cash Price |
$46.52
|
| Rate for Payer: Devoted Health Medicare |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.64
|
| Rate for Payer: Health Management Network Commercial |
$65.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$30.72
|
|
