|
25675-Clsd Treat Distal Radioulnar Disloc w/ Manip
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
8957889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$694.00
|
| Rate for Payer: Cash Price |
$902.20
|
| Rate for Payer: Cash Price |
$902.20
|
| Rate for Payer: Cash Price |
$902.20
|
| Rate for Payer: Devoted Health Medicare |
$763.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$694.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,318.60
|
| Rate for Payer: Health Management Network Commercial |
$1,179.80
|
| Rate for Payer: Humana Medicare |
$694.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,249.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$694.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,346.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$694.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$694.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$694.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,011.71
|
|
|
25680 CLOSED TREATMENTTRANS-SCAPHOPERILUNAR TYPEFRACTURE DISLOC W/ MANIP TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8023006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$421.50
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Devoted Health Medicare |
$463.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$421.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.85
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Humana Medicare |
$421.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.50
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$421.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.50
|
| Rate for Payer: University Health Alliance Commercial |
$614.46
|
|
|
25680 CLOSED TREATMENTTRANS-SCAPHOPERILUNAR TYPEFRACTURE DISLOC W/ MANIP TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
8023006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$716.55 |
| Max. Negotiated Rate |
$817.71 |
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
|
|
25690-Lunate w/ Manipulation
|
Facility
|
OP
|
$7,150.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
8080095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,935.50 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$3,575.00
|
| Rate for Payer: Cash Price |
$4,647.50
|
| Rate for Payer: Cash Price |
$4,647.50
|
| Rate for Payer: Cash Price |
$4,647.50
|
| Rate for Payer: Devoted Health Medicare |
$3,932.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,575.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,792.50
|
| Rate for Payer: Health Management Network Commercial |
$6,077.50
|
| Rate for Payer: Humana Medicare |
$3,575.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,435.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,575.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,935.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,575.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,575.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,575.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,211.64
|
|
|
25690-Lunate w/ Manipulation
|
Facility
|
IP
|
$7,150.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
8080095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,077.50 |
| Max. Negotiated Rate |
$6,935.50 |
| Rate for Payer: Cash Price |
$4,647.50
|
| Rate for Payer: Health Management Network Commercial |
$6,077.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,435.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,935.50
|
|
|
2.5MM DRILL BIT
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
12944053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
2.5MM DRILL BIT
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
12944053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$111.50
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$122.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.85
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$111.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.50
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.50
|
| Rate for Payer: University Health Alliance Commercial |
$162.54
|
|
|
2.5MM DRILL BIT, CALIBRATED
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
12944054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
2.5MM DRILL BIT, CALIBRATED
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
12944054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$111.50
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$122.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.85
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$111.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.50
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.50
|
| Rate for Payer: University Health Alliance Commercial |
$162.54
|
|
|
25-OH Vitamin D2 D3 FSI
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
11283167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: AlohaCare Medicaid |
$158.50
|
| Rate for Payer: AlohaCare Medicare |
$158.50
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Devoted Health Medicare |
$174.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.60
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Humana Medicare |
$158.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.50
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.50
|
| Rate for Payer: University Health Alliance Commercial |
$76.52
|
|
|
25-OH Vitamin D2 D3 FSI
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
11283167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.30
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
|
|
26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8023012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$389.50
|
| Rate for Payer: Cash Price |
$506.35
|
| Rate for Payer: Cash Price |
$506.35
|
| Rate for Payer: Cash Price |
$506.35
|
| Rate for Payer: Devoted Health Medicare |
$428.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$740.05
|
| Rate for Payer: Health Management Network Commercial |
$662.15
|
| Rate for Payer: Humana Medicare |
$389.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$701.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.50
|
| Rate for Payer: MDX Hawaii PPO |
$755.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.50
|
| Rate for Payer: University Health Alliance Commercial |
$567.81
|
|
|
26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8023012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$662.15 |
| Max. Negotiated Rate |
$755.63 |
| Rate for Payer: Cash Price |
$506.35
|
| Rate for Payer: Health Management Network Commercial |
$662.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$701.10
|
| Rate for Payer: MDX Hawaii PPO |
$755.63
|
|
|
26010-I&D Finger Abscess Simple
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8080059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$687.73 |
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Health Management Network Commercial |
$602.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$638.10
|
| Rate for Payer: MDX Hawaii PPO |
$687.73
|
|
|
26010-I&D Finger Abscess Simple
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
8080059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$354.50
|
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Cash Price |
$460.85
|
| Rate for Payer: Devoted Health Medicare |
$389.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$673.55
|
| Rate for Payer: Health Management Network Commercial |
$602.65
|
| Rate for Payer: Humana Medicare |
$354.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$638.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.50
|
| Rate for Payer: MDX Hawaii PPO |
$687.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.50
|
| Rate for Payer: University Health Alliance Commercial |
$516.79
|
|
|
26011-I&D Finger Abscess Complicated
|
Facility
|
IP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
8080061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,161.65 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
|
|
26011-I&D Finger Abscess Complicated
|
Facility
|
OP
|
$7,249.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
8080061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$7,031.53 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$3,624.50
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Cash Price |
$4,711.85
|
| Rate for Payer: Devoted Health Medicare |
$3,986.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,624.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,886.55
|
| Rate for Payer: Health Management Network Commercial |
$6,161.65
|
| Rate for Payer: Humana Medicare |
$3,624.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,524.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,624.50
|
| Rate for Payer: MDX Hawaii PPO |
$7,031.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,624.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,624.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,624.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
26160 Excision of lesion of tendon sheath or joint capsule, hand or finger
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
8037912
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$1,902.30 |
| Rate for Payer: AlohaCare Medicaid |
$341.51
|
| Rate for Payer: AlohaCare Medicare |
$322.68
|
| Rate for Payer: Cash Price |
$1,454.70
|
| Rate for Payer: Cash Price |
$1,454.70
|
| Rate for Payer: Devoted Health Medicare |
$354.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$341.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$556.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$322.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$341.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$238.42
|
| Rate for Payer: Health Management Network Commercial |
$1,902.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$354.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$341.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$341.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.68
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
26356 REPAIR FLEXOR TENDON, ZONE 2 TechFee
|
Facility
|
OP
|
$6,813.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
8023030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,379.34
|
| Rate for Payer: AlohaCare Medicare |
$3,406.50
|
| Rate for Payer: Cash Price |
$4,428.45
|
| Rate for Payer: Cash Price |
$4,428.45
|
| Rate for Payer: Devoted Health Medicare |
$3,747.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,406.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,472.35
|
| Rate for Payer: Health Management Network Commercial |
$5,791.05
|
| Rate for Payer: Humana Medicare |
$3,406.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,131.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,406.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,608.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,406.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,406.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,406.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
26356 REPAIR FLEXOR TENDON, ZONE 2 TechFee
|
Facility
|
IP
|
$6,813.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
8023030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,791.05 |
| Max. Negotiated Rate |
$6,608.61 |
| Rate for Payer: Cash Price |
$4,428.45
|
| Rate for Payer: Health Management Network Commercial |
$5,791.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,131.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,608.61
|
|
|
26418 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH TechFee
|
Facility
|
OP
|
$8,712.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
8023034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$1,379.34
|
| Rate for Payer: AlohaCare Medicare |
$4,356.00
|
| Rate for Payer: Cash Price |
$5,662.80
|
| Rate for Payer: Cash Price |
$5,662.80
|
| Rate for Payer: Devoted Health Medicare |
$4,791.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,356.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,276.40
|
| Rate for Payer: Health Management Network Commercial |
$7,405.20
|
| Rate for Payer: Humana Medicare |
$4,356.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,840.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,356.00
|
| Rate for Payer: MDX Hawaii PPO |
$8,450.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,356.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,356.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,356.00
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
26418 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH TechFee
|
Facility
|
IP
|
$8,712.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
8023034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,405.20 |
| Max. Negotiated Rate |
$8,450.64 |
| Rate for Payer: Cash Price |
$5,662.80
|
| Rate for Payer: Health Management Network Commercial |
$7,405.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,840.80
|
| Rate for Payer: MDX Hawaii PPO |
$8,450.64
|
|
|
26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
8023058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$421.50
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Devoted Health Medicare |
$463.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$421.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$800.85
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Humana Medicare |
$421.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.50
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$421.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$421.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$421.50
|
| Rate for Payer: University Health Alliance Commercial |
$614.46
|
|
|
26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
8023058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$716.55 |
| Max. Negotiated Rate |
$817.71 |
| Rate for Payer: Cash Price |
$547.95
|
| Rate for Payer: Health Management Network Commercial |
$716.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$758.70
|
| Rate for Payer: MDX Hawaii PPO |
$817.71
|
|
|
26605-Metacarpal w/ Manipulation
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
8080127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
