|
28104 Excision or curettage of bone cyst or benign tumor, tarsal/metatarsal, except talus/calcaneus
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
8038322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.32 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$372.93
|
| Rate for Payer: AlohaCare Medicare |
$350.44
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$385.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$372.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$607.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$350.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$372.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$294.32
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$350.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$372.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$350.44
|
| Rate for Payer: University Health Alliance Commercial |
$478.35
|
|
|
28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
8038324
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$311.24
|
| Rate for Payer: AlohaCare Medicare |
$293.52
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$322.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$311.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$502.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$293.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$311.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$322.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$322.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$322.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$311.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$293.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$311.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$293.52
|
| Rate for Payer: University Health Alliance Commercial |
$389.51
|
|
|
28118 Ostectomy, calcaneus;
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28118
|
| Hospital Charge Code |
8038330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.03 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$443.88
|
| Rate for Payer: AlohaCare Medicare |
$418.03
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$459.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$443.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$725.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$418.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$443.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.26
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$459.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$459.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$418.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$443.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$418.03
|
| Rate for Payer: University Health Alliance Commercial |
$571.02
|
|
|
28122 Partial excision of bone; tarsal or metatarsal bone, except talus or calcaneus
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
8038333
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.44 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$460.87
|
| Rate for Payer: AlohaCare Medicare |
$429.44
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$472.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$460.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$751.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$429.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$460.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$472.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$460.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$429.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$460.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$429.44
|
| Rate for Payer: University Health Alliance Commercial |
$574.43
|
|
|
28140 Metatarsectomy
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28140
|
| Hospital Charge Code |
8038337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.16 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$437.48
|
| Rate for Payer: AlohaCare Medicare |
$401.97
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$442.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$437.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$730.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$401.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$437.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$368.16
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$442.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$401.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$437.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$401.97
|
| Rate for Payer: University Health Alliance Commercial |
$575.70
|
|
|
28190-Foot Subcutaneous
|
Facility
|
OP
|
$1,831.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
8080143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$915.50
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Devoted Health Medicare |
$1,007.05
|
| 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 |
$915.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,739.45
|
| Rate for Payer: Health Management Network Commercial |
$1,556.35
|
| Rate for Payer: Humana Medicare |
$915.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,647.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$915.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,776.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$915.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$915.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$915.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
28190-Foot Subcutaneous
|
Facility
|
IP
|
$1,831.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
8080143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,556.35 |
| Max. Negotiated Rate |
$1,776.07 |
| Rate for Payer: Cash Price |
$1,190.15
|
| Rate for Payer: Health Management Network Commercial |
$1,556.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,647.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,776.07
|
|
|
28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
8023256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Devoted Health Medicare |
$1,175.90
|
| 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 |
$1,069.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,031.10
|
| Rate for Payer: Health Management Network Commercial |
$1,817.30
|
| Rate for Payer: Humana Medicare |
$1,069.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,924.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,069.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,073.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,069.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,069.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,069.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
8023256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,817.30 |
| Max. Negotiated Rate |
$2,073.86 |
| Rate for Payer: Cash Price |
$1,389.70
|
| Rate for Payer: Health Management Network Commercial |
$1,817.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,924.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,073.86
|
|
|
28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
8038357
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$409.22
|
| Rate for Payer: AlohaCare Medicare |
$384.91
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$423.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$409.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$642.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$384.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$409.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$423.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$423.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$409.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$384.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$409.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$384.91
|
| Rate for Payer: University Health Alliance Commercial |
$511.86
|
|
|
28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
8038358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.38 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$462.47
|
| Rate for Payer: AlohaCare Medicare |
$434.04
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$477.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$462.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$752.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$462.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$354.38
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$477.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$477.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$462.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.04
|
| Rate for Payer: University Health Alliance Commercial |
$592.53
|
|
|
28289 Hallux rigidus correction w/ cheilectomy, debridement & capsular release of first mtpj
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
8038359
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.86 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$484.82
|
| Rate for Payer: AlohaCare Medicare |
$452.56
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$497.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$484.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$803.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$452.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$484.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$431.86
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$497.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$497.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$497.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$452.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$484.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$452.56
|
| Rate for Payer: University Health Alliance Commercial |
$604.67
|
|
|
28292 Correction, hallux valgus (bunion), w/ or w/o sesamoidectomy; Keller, Mayo type procedure
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28292
|
| Hospital Charge Code |
8038360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$511.62
|
| Rate for Payer: AlohaCare Medicare |
$475.23
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$522.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$511.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$881.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$511.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.08
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$522.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$522.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$511.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.23
|
| Rate for Payer: University Health Alliance Commercial |
$638.24
|
|
|
28295 CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; WITH PR ProFee
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
8018207
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$578.92 |
| Max. Negotiated Rate |
$3,870.90 |
| Rate for Payer: AlohaCare Medicaid |
$630.67
|
| Rate for Payer: AlohaCare Medicare |
$578.92
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$636.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$630.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,063.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$578.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$630.67
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$636.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$636.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$636.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$630.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$578.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$630.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$578.92
|
| Rate for Payer: University Health Alliance Commercial |
$837.53
|
|
|
28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy
|
Professional
|
Both
|
$10,099.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
8038365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$578.15 |
| Max. Negotiated Rate |
$8,584.15 |
| Rate for Payer: AlohaCare Medicaid |
$621.62
|
| Rate for Payer: AlohaCare Medicare |
$578.15
|
| Rate for Payer: Cash Price |
$6,564.35
|
| Rate for Payer: Cash Price |
$6,564.35
|
| Rate for Payer: Devoted Health Medicare |
$635.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$621.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,013.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$578.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$621.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$720.72
|
| Rate for Payer: Health Management Network Commercial |
$8,584.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$635.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$635.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$635.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$621.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$578.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$621.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$578.15
|
| Rate for Payer: University Health Alliance Commercial |
$793.78
|
|
|
28400 CALCANEAL FX TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
8023293
|
|
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
|
|
|
28400 CALCANEAL FX TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
8023293
|
|
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
|
|
|
28435-Talus w/ Manipulation
|
Facility
|
IP
|
$7,150.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
8080128
|
|
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
|
|
|
28435-Talus w/ Manipulation
|
Facility
|
OP
|
$7,150.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
8080128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| 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 |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,575.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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
|
|
|
28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
8023301
|
|
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
|
|
|
28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
8023301
|
|
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
|
|
|
28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH TechFee
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
8023302
|
|
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
|
|
|
28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH TechFee
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
8023302
|
|
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
|
|
|
28495-Great Toe w/ Manipulation
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
8080130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$720.50
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$792.55
|
| 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 |
$720.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$720.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$720.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$720.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
28495-Great Toe w/ Manipulation
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
8080130
|
|
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
|
|
