|
PR CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO
|
Professional
|
Both
|
$93.12
|
|
|
Service Code
|
HCPCS 99439
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$79.15 |
| Rate for Payer: AlohaCare Medicaid |
$35.33
|
| Rate for Payer: AlohaCare Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Devoted Health Medicare |
$33.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.33
|
| Rate for Payer: Health Management Network Commercial |
$79.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.80
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 54161
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: AlohaCare Medicaid |
$202.13
|
| Rate for Payer: AlohaCare Medicare |
$183.18
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$201.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.18
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.18
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$424.04
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$360.43 |
| Rate for Payer: AlohaCare Medicaid |
$148.14
|
| Rate for Payer: AlohaCare Medicare |
$132.94
|
| Rate for Payer: Cash Price |
$254.42
|
| Rate for Payer: Cash Price |
$254.42
|
| Rate for Payer: Devoted Health Medicare |
$146.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$148.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$244.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$360.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$148.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.94
|
| Rate for Payer: University Health Alliance Commercial |
$192.75
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$279.76
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$237.80 |
| Rate for Payer: AlohaCare Medicaid |
$94.88
|
| Rate for Payer: AlohaCare Medicare |
$82.76
|
| Rate for Payer: Cash Price |
$167.86
|
| Rate for Payer: Cash Price |
$167.86
|
| Rate for Payer: Devoted Health Medicare |
$91.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$94.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.10
|
| Rate for Payer: Health Management Network Commercial |
$237.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.76
|
| Rate for Payer: University Health Alliance Commercial |
$126.42
|
|
|
PR CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$373.36 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: AlohaCare Medicaid |
$622.24
|
| Rate for Payer: AlohaCare Medicare |
$581.61
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Devoted Health Medicare |
$639.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$581.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$373.36
|
| Rate for Payer: Health Management Network Commercial |
$906.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$697.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$697.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$697.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$581.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$622.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$581.61
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$604.43
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$321.09 |
| Max. Negotiated Rate |
$513.77 |
| Rate for Payer: AlohaCare Medicaid |
$324.03
|
| Rate for Payer: AlohaCare Medicare |
$321.09
|
| Rate for Payer: Cash Price |
$362.66
|
| Rate for Payer: Cash Price |
$362.66
|
| Rate for Payer: Devoted Health Medicare |
$353.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$324.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$324.03
|
| Rate for Payer: Health Management Network Commercial |
$513.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$385.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$324.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.09
|
| Rate for Payer: University Health Alliance Commercial |
$411.82
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$707.56
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$195.26 |
| Max. Negotiated Rate |
$601.43 |
| Rate for Payer: AlohaCare Medicaid |
$338.06
|
| Rate for Payer: AlohaCare Medicare |
$342.80
|
| Rate for Payer: Cash Price |
$424.54
|
| Rate for Payer: Cash Price |
$424.54
|
| Rate for Payer: Devoted Health Medicare |
$377.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$338.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$338.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$195.26
|
| Rate for Payer: Health Management Network Commercial |
$601.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$411.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$411.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$411.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$338.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$338.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.80
|
| Rate for Payer: University Health Alliance Commercial |
$430.73
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$829.40
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$196.04 |
| Max. Negotiated Rate |
$704.99 |
| Rate for Payer: AlohaCare Medicaid |
$416.32
|
| Rate for Payer: AlohaCare Medicare |
$473.56
|
| Rate for Payer: Cash Price |
$497.64
|
| Rate for Payer: Cash Price |
$497.64
|
| Rate for Payer: Devoted Health Medicare |
$520.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$473.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$196.04
|
| Rate for Payer: Health Management Network Commercial |
$704.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$568.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$473.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$473.56
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$883.15 |
| Rate for Payer: AlohaCare Medicaid |
$459.63
|
| Rate for Payer: AlohaCare Medicare |
$482.32
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Devoted Health Medicare |
$530.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$459.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$459.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$337.48
|
| Rate for Payer: Health Management Network Commercial |
$883.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$578.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$578.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$459.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.32
|
| Rate for Payer: University Health Alliance Commercial |
$588.59
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$718.43
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$204.88 |
| Max. Negotiated Rate |
$610.67 |
| Rate for Payer: AlohaCare Medicaid |
$339.84
|
| Rate for Payer: AlohaCare Medicare |
$339.51
|
| Rate for Payer: Cash Price |
$431.06
|
| Rate for Payer: Cash Price |
$431.06
|
| Rate for Payer: Devoted Health Medicare |
$373.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$339.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$339.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$204.88
|
| Rate for Payer: Health Management Network Commercial |
$610.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$407.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$407.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.51
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$929.27
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$789.88 |
| Rate for Payer: AlohaCare Medicaid |
$437.70
|
| Rate for Payer: AlohaCare Medicare |
$414.80
|
| Rate for Payer: Cash Price |
$557.56
|
| Rate for Payer: Cash Price |
$557.56
|
| Rate for Payer: Devoted Health Medicare |
$456.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$437.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$414.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$437.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.06
|
| Rate for Payer: Health Management Network Commercial |
$789.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$497.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$497.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$497.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$414.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$437.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$414.80
|
| Rate for Payer: University Health Alliance Commercial |
$484.47
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$509.56
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$176.28 |
| Max. Negotiated Rate |
$433.13 |
| Rate for Payer: AlohaCare Medicaid |
$254.96
|
| Rate for Payer: AlohaCare Medicare |
$249.03
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Cash Price |
$305.74
|
| Rate for Payer: Devoted Health Medicare |
$273.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$254.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$254.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$176.28
|
| Rate for Payer: Health Management Network Commercial |
$433.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$254.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$254.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.03
|
| Rate for Payer: University Health Alliance Commercial |
$360.00
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$1,022.74
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$280.54 |
| Max. Negotiated Rate |
$869.33 |
| Rate for Payer: UnitedHealthcare Medicare |
$467.45
|
| Rate for Payer: AlohaCare Medicaid |
$487.07
|
| Rate for Payer: AlohaCare Medicare |
$467.45
|
| Rate for Payer: Cash Price |
$613.64
|
| Rate for Payer: Cash Price |
$613.64
|
| Rate for Payer: Devoted Health Medicare |
$514.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$487.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$467.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$487.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$280.54
|
| Rate for Payer: Health Management Network Commercial |
$869.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$560.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$560.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$560.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$487.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$467.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$487.07
|
| Rate for Payer: University Health Alliance Commercial |
$623.90
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$658.44
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$228.28 |
| Max. Negotiated Rate |
$559.67 |
| Rate for Payer: AlohaCare Medicaid |
$316.95
|
| Rate for Payer: AlohaCare Medicare |
$313.96
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Devoted Health Medicare |
$345.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$316.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$316.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.28
|
| Rate for Payer: Health Management Network Commercial |
$559.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.96
|
| Rate for Payer: University Health Alliance Commercial |
$420.00
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,052.20
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$894.37 |
| Rate for Payer: AlohaCare Medicaid |
$507.27
|
| Rate for Payer: AlohaCare Medicare |
$476.13
|
| Rate for Payer: Cash Price |
$631.32
|
| Rate for Payer: Cash Price |
$631.32
|
| Rate for Payer: Devoted Health Medicare |
$523.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$507.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$476.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$507.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$397.28
|
| Rate for Payer: Health Management Network Commercial |
$894.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$571.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$571.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$571.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$476.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$507.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$476.13
|
| Rate for Payer: University Health Alliance Commercial |
$657.92
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: AlohaCare Medicaid |
$669.12
|
| Rate for Payer: AlohaCare Medicare |
$621.45
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Devoted Health Medicare |
$683.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$621.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$977.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$745.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$745.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$745.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$669.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$621.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$669.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$621.45
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$2,146.60
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$483.86 |
| Max. Negotiated Rate |
$1,824.61 |
| Rate for Payer: AlohaCare Medicaid |
$1,017.50
|
| Rate for Payer: AlohaCare Medicare |
$966.11
|
| Rate for Payer: Cash Price |
$1,287.96
|
| Rate for Payer: Cash Price |
$1,287.96
|
| Rate for Payer: Devoted Health Medicare |
$1,062.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,017.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,467.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$966.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,017.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$483.86
|
| Rate for Payer: Health Management Network Commercial |
$1,824.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,159.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,159.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,159.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,017.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$966.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,017.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$966.11
|
| Rate for Payer: University Health Alliance Commercial |
$1,225.12
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$446.55
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$379.57 |
| Rate for Payer: AlohaCare Medicaid |
$228.27
|
| Rate for Payer: AlohaCare Medicare |
$222.89
|
| Rate for Payer: Cash Price |
$267.93
|
| Rate for Payer: Cash Price |
$267.93
|
| Rate for Payer: Devoted Health Medicare |
$245.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$228.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$228.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$379.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$228.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$228.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.89
|
| Rate for Payer: University Health Alliance Commercial |
$320.00
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$327.86 |
| Max. Negotiated Rate |
$916.30 |
| Rate for Payer: AlohaCare Medicaid |
$626.72
|
| Rate for Payer: AlohaCare Medicare |
$585.62
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Devoted Health Medicare |
$644.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$585.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$327.86
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$702.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$702.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$626.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$585.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$626.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$585.62
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$305.60
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$259.76 |
| Rate for Payer: AlohaCare Medicaid |
$60.57
|
| Rate for Payer: AlohaCare Medicare |
$53.86
|
| Rate for Payer: Cash Price |
$183.36
|
| Rate for Payer: Cash Price |
$183.36
|
| Rate for Payer: Devoted Health Medicare |
$59.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$60.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$60.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$259.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.86
|
| Rate for Payer: University Health Alliance Commercial |
$78.92
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$419.39
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$356.48 |
| Rate for Payer: AlohaCare Medicaid |
$96.42
|
| Rate for Payer: AlohaCare Medicare |
$81.66
|
| Rate for Payer: Cash Price |
$251.63
|
| Rate for Payer: Cash Price |
$251.63
|
| Rate for Payer: Devoted Health Medicare |
$89.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$194.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$186.94
|
| Rate for Payer: Health Management Network Commercial |
$356.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.66
|
| Rate for Payer: University Health Alliance Commercial |
$200.00
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$805.88
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: AlohaCare Medicaid |
$322.59
|
| Rate for Payer: AlohaCare Medicare |
$296.06
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Cash Price |
$483.53
|
| Rate for Payer: Devoted Health Medicare |
$325.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$322.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$527.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$322.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.14
|
| Rate for Payer: Health Management Network Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$322.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$322.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.06
|
| Rate for Payer: University Health Alliance Commercial |
$415.57
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: AlohaCare Medicaid |
$371.11
|
| Rate for Payer: AlohaCare Medicare |
$417.92
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Devoted Health Medicare |
$459.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$371.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$417.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$371.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.16
|
| Rate for Payer: Health Management Network Commercial |
$737.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$501.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$501.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$417.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$371.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$417.92
|
| Rate for Payer: University Health Alliance Commercial |
$468.81
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$692.77
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: AlohaCare Medicaid |
$333.47
|
| Rate for Payer: AlohaCare Medicare |
$328.65
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Cash Price |
$415.66
|
| Rate for Payer: Devoted Health Medicare |
$361.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$333.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$328.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$333.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$208.00
|
| Rate for Payer: Health Management Network Commercial |
$588.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$394.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$333.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$328.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$333.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$328.65
|
| Rate for Payer: University Health Alliance Commercial |
$425.02
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.40
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$841.84 |
| Rate for Payer: AlohaCare Medicaid |
$442.70
|
| Rate for Payer: AlohaCare Medicare |
$462.64
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Cash Price |
$594.24
|
| Rate for Payer: Devoted Health Medicare |
$508.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$442.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$442.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$258.44
|
| Rate for Payer: Health Management Network Commercial |
$841.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$555.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$442.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$442.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.64
|
| Rate for Payer: University Health Alliance Commercial |
$563.21
|
|
