|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| 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 |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$9,416.00
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| 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 |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$17,484.00
|
|
|
Service Code
|
CPT 49616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$17,484.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 49615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$7,647.81
|
| Rate for Payer: AlohaCare Medicare |
$7,647.81
|
| Rate for Payer: Devoted Health Medicare |
$8,412.59
|
| 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 |
$7,647.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$7,647.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,647.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,412.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,647.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,647.81
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$17,484.00
|
|
|
Service Code
|
CPT 49618
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$17,484.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, REDUCIBLE
|
Facility
|
OP
|
$17,484.00
|
|
|
Service Code
|
CPT 49617
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$17,484.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,484.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 49613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| 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 |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE
|
Facility
|
OP
|
$5,160.40
|
|
|
Service Code
|
CPT 36576
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,859.62
|
| Rate for Payer: AlohaCare Medicare |
$1,859.62
|
| Rate for Payer: Devoted Health Medicare |
$2,045.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,859.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Humana Medicare |
$1,859.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,859.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,045.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,859.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,859.62
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
|
Facility
|
OP
|
$10,715.11
|
|
|
Service Code
|
CPT 25425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,715.11 |
| 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 Commercial |
$10,715.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| 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
|
|
|
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 65280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$6,286.29
|
| Rate for Payer: AlohaCare Medicare |
$6,286.29
|
| Rate for Payer: Devoted Health Medicare |
$6,914.92
|
| 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 |
$6,286.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$6,286.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,286.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,914.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,286.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,286.29
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL TISSUE
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 65285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$6,286.29
|
| Rate for Payer: AlohaCare Medicare |
$6,286.29
|
| Rate for Payer: Devoted Health Medicare |
$6,914.92
|
| 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 |
$6,286.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$6,286.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,286.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,914.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,286.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,286.29
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 65275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$4,644.34
|
| Rate for Payer: AlohaCare Medicare |
$4,644.34
|
| Rate for Payer: Devoted Health Medicare |
$5,108.77
|
| 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 |
$4,644.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$4,644.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,644.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,108.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,644.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,644.34
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 25400
|
|
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
|
|
|
REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 54437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$14,715.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,164.22
|
| Rate for Payer: AlohaCare Medicare |
$4,164.22
|
| Rate for Payer: Devoted Health Medicare |
$4,580.64
|
| 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 |
$4,164.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,154.45
|
| Rate for Payer: Humana Medicare |
$4,164.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,164.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,580.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,164.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,164.22
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27650
|
|
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
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 27652
|
|
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
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$16,700.00
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,229.69
|
| Rate for Payer: AlohaCare Medicare |
$4,229.69
|
| Rate for Payer: Devoted Health Medicare |
$4,652.66
|
| 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 |
$4,229.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$4,229.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,229.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,652.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,229.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,229.69
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
|
REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 27698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
|
Facility
|
OP
|
$6,743.44
|
|
|
Service Code
|
CPT 28208
|
|
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
|
|
|
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES ROTATOR CUFF)
|
Facility
|
OP
|
$9,429.30
|
|
|
Service Code
|
CPT 24341
|
|
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
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$6,183.00
|
|
|
Service Code
|
CPT 36581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| 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 |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REPLACEMENT OF DUODENOSTOMY OR JEJUNOSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 49451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$295.16
|
| Rate for Payer: AlohaCare Medicare |
$295.16
|
| Rate for Payer: Devoted Health Medicare |
$324.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$368.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.16
|
| Rate for Payer: Humana Medicare |
$295.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.16
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$3,972.38
|
|
|
Service Code
|
APR-DRG 1332
|
| Min. Negotiated Rate |
$3,972.38 |
| Max. Negotiated Rate |
$3,972.38 |
| Rate for Payer: AlohaCare Medicaid |
$3,972.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,972.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,972.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,972.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,972.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,972.38
|
|
