|
OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,416.00
|
|
|
Service Code
|
CPT 28505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH INTERNAL FIXATION, WHEN PERFORMED; OF TIBIA ONLY
|
Facility
|
OP
|
$16,683.60
|
|
|
Service Code
|
CPT 27827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$16,683.60 |
| Rate for Payer: AlohaCare Medicaid |
$15,166.91
|
| Rate for Payer: AlohaCare Medicare |
$15,166.91
|
| Rate for Payer: Devoted Health Medicare |
$16,683.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,166.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$15,166.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16,683.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,166.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,166.91
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 28525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$16,683.60
|
|
|
Service Code
|
CPT 24579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$16,683.60 |
| Rate for Payer: AlohaCare Medicaid |
$15,166.91
|
| Rate for Payer: AlohaCare Medicare |
$15,166.91
|
| Rate for Payer: Devoted Health Medicare |
$16,683.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,166.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$15,166.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16,683.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,166.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,166.91
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; WITHOUT INTERCONDYLAR EXTENSION
|
Facility
|
OP
|
$16,683.60
|
|
|
Service Code
|
CPT 24545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$16,683.60 |
| Rate for Payer: AlohaCare Medicaid |
$15,166.91
|
| Rate for Payer: AlohaCare Medicare |
$15,166.91
|
| Rate for Payer: Devoted Health Medicare |
$16,683.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,166.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$15,166.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16,683.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,166.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,166.91
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH BONE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 26615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 28485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE PATELLECTOMY AND SOFT TISSUE REPAIR
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 27524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 26735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27769
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
|
|
OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFORMED; OF RADIUS AND ULNA
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 25575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 25515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 28555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 28615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 27535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 27823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,715.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$9,429.30 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
OPIOID ABUSE & DEPENDENCE
|
Facility
|
IP
|
$10,645.79
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$10,645.79 |
| Max. Negotiated Rate |
$10,645.79 |
| Rate for Payer: AlohaCare Medicaid |
$10,645.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10,645.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10,645.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,645.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10,645.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10,645.79
|
|
|
OPIOID ABUSE & DEPENDENCE
|
Facility
|
IP
|
$2,419.60
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$2,419.60 |
| Max. Negotiated Rate |
$2,419.60 |
| Rate for Payer: AlohaCare Medicaid |
$2,419.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2,419.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,419.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,419.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,419.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,419.60
|
|
|
OPIOID ABUSE & DEPENDENCE
|
Facility
|
IP
|
$4,495.73
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$4,495.73 |
| Max. Negotiated Rate |
$4,495.73 |
| Rate for Payer: AlohaCare Medicaid |
$4,495.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,495.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,495.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,495.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,495.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,495.73
|
|
|
OPIOID ABUSE & DEPENDENCE
|
Facility
|
IP
|
$1,594.27
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$1,594.27 |
| Max. Negotiated Rate |
$1,594.27 |
| Rate for Payer: AlohaCare Medicaid |
$1,594.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,594.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,594.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,594.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,594.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,594.27
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) PO TINC
|
Facility
|
IP
|
$20.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Health Management Network Commercial |
$17.65
|
| Rate for Payer: MDX Hawaii PPO |
$20.15
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) PO TINC
|
Facility
|
OP
|
$20.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.73
|
| Rate for Payer: Health Management Network Commercial |
$17.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.59
|
| Rate for Payer: MDX Hawaii PPO |
$20.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.46
|
| Rate for Payer: University Health Alliance Commercial |
$15.14
|
|
|
Optilume DCB 24FR OPTBDL7009B [3643200]
|
Facility
|
OP
|
$14,628.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
3643200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,460.28 |
| Max. Negotiated Rate |
$14,189.16 |
| Rate for Payer: Cash Price |
$9,508.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,896.60
|
| Rate for Payer: Health Management Network Commercial |
$12,433.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,215.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7,460.28
|
| Rate for Payer: MDX Hawaii PPO |
$14,189.16
|
| Rate for Payer: University Health Alliance Commercial |
$10,662.35
|
|
